COVID Vaccine Legalities and Logistical Challenges

okay hello everyone my name is jeff dannell and i'm president of enterprise health and i'd like to welcome everybody to today's webinar focused on the legal and logistical challenges that are associated with the administration of the covid19 vaccine this is the ninth in a series of webinars that we've initiated last year in response to the covid19 pandemic and today we have more than 365 individuals who've registered for the session so obviously this is an important and timely topic and we appreciate everyone especially those of you who are braving really difficult weather conditions these days i know here in indiana we have about a foot of snow on the ground but we want to thank all of you for making time and we also want to thank our friends at work health solutions who are co-sponsoring today's event and we're going to start off with just a couple of housekeeping items we've muted everybody except our moderators and our panelists and we're trying to minimize background noise as much as possible want to let you know we are recording this session and we will email everybody later this week with the link to access the recording and we have a great panel with us today it's a group of legal and occupational and employee health experts and they include enterprise health clients and partners and we've asked each of our panelists to make a few initial remarks about their observations on today's topic and then we're going to have a q a session so you can submit questions via the chat or the the q a feature in webex and we'll get to as many as we possibly can after our speakers kind of give you an overview and our panelists today include dean frieders with work health solutions amy adelaide with creig de vault and tim ray cobb and amanda guilfoyle with philip 66. and i'm going to start off and just give a little context on our organization as well as today's topic and i know none of us are spending too much time in elevators these days but this is the quick enterprise health elevator pitch and we are the only cloud-based health it solution that combines occupational health and compliance clinical care and employee engagement on a single interoperable and certified electronic health record platform and we focus on equipping our clients and their employees for a healthier future and we work with a mix of blue chip global corporations government agencies and hospitals and health systems who operate their own on-site employee health clinics and also provide employee health services to other organizations now i was recently watching the bbc world news and i was reminded that in the united kingdom they refer to back to a vaccination not as a shot but as a jab and as i watch the story of the measures that great britain has put in place to jab its citizens it brought back memories of attending boxing matches as a kid with my father and you'd hear the corner man barking out instructions to the fighter to jab jab jab and of course the opposing fighter is doing their best to avoid the punches and today we find ourselves engaged in really an epic and global fight against kobit 19. and one of our best weapons is administering a flurry of multiple jabs in the shortest time possible to put our opponent which in this case is a virus and it's rapidly multiplying variants on the ropes and ideally out cold on the floor of the ring but this coronavirus has proved to be pretty wily a sky skilled fighter if you will and despite all of our training we haven't really encountered an opponent quite like this in the opposite corner in roughly a century and getting all those jabs in has proved to be a rather daunting task and we're wrestling with some some heavyweight issues including things like the the fact the actual timing of vaccine rollout was a bit of a mystery and many were caught by surprise when vaccines all of a sudden became available in mid-december and that triggered a mad scramble among states hospitals and health systems and others who were involved in coordinating the first round of vaccines here in the u.

s vaccination logistics were left largely to states and every state is doing things a bit differently in terms of risk ratification for groups for allocating vaccines and in addition every state has some kind of a vaccine registry and in some states there are even county and city registries add in a change of administration at the presidential level and the complexity and rate of change and refinement has been nothing short of dizzying and of course there's not just one approved vaccine but several with different transportation and storage requirements and the initially approved vaccines require two doses with the second doses administered at different intervals and then we have new vaccines coming online soon to add to the complexity and we also have people advocating giving out the first dose of a double dose to more people and delaying the second dose just so we get more people to have that that first round again it adds up to more complexity and this is a moving bobbin and weaving target and i know as we gear up to expand vaccination sites and work some through some of the early bugs we're starting to run into supply issues many cities and localities are turning arena arenas and stadiums and pharmacies into mass vaccination sites but they don't yet have mass vaccination supplies and across the pond we're seeing europe and the uk engage in some post-brexit bickering over vaccine availability and there are many third world countries where they have yet to administer their very first vaccine and then just to make things more challenging there's a full spectrum of attitudes and behaviors associated with vaccination and that ranges from those who are so eager to get jabbed they're trying to cut the line to those who are dead set against getting the vaccine for a whole host of reasons and i know at enterprise health we've been working with our clients to help them manage their copic vaccination efforts and we were fortunate in that we did not have to start from scratch on this effort we were able to modify some existing mass immunization functionality that's traditionally used for things like annual employee flu programs however it was not quite as simple as just adding another vaccine to that module and calling it a day given all the aforementioned complexity and we were very lucky in that one of our health system clients northwell health in new york really anticipated that the vaccine would be available in december and so we started working with them well in advance to prepare and they actually administered the very first vaccine given in the u. s to one of their nurses on the morning of december 14th but certainly over the last 60 days or so it has been nothing short of a mad scramble as we worked first with our health system clients to get their employees vaccinated and now a lot of our corporate clients are gearing up for their vaccination programs and we've been able to amass quite a bit of experience in a short time we've been refining functionality on an almost daily basis based on feedback from administration sites we've quickly set up dozens of new interfaces with different registries uh we've created a lot of new reports to track progress and really was as with all things covet over the last year our clients and really by extension our organization has had to operate on an unbelievably agile footing and then just to make things more interesting several of our clients have recently asked to use our solution not just to manage vaccinations for employees which is really what our solution is built to do but also to use it for vaccinating the wider community things like first responders essential workers spouses family members really anybody approved to get a vaccine and you know we're as eager as anybody to speed up the pace of vaccination and get back to some kind of a semblance of business as usual so we are happy to help our clients as they jab jab jab and of course our clients like everybody i'm sure attending this webinar everybody's dealing with all kinds of legal and logistical challenges can you require employees to get vaccinated what kind of proof of vaccination is required how should you document declinations how do you set up a mass vaccination program what precautions do you need to put in place when vaccinating given covid what role should technology play how do you educate employees and community members on vaccine benefits and overcome some of those fears and concerns so fortunately we have a great panel who's going to enlighten us on some of these topics today and our first panelist is amy adelaide and amy is a partner and chair of the labor and employment practice at crete de vault and it's a law first firm that we work with and they specialize in occupational and employee health and amy has been very active in helping a wide array of employer clients address covet-related legal regulatory and compliance issues and she's going to talk about some of the the applicable regulatory standards and their impact on employers and employees amy let me pull your slides up here all right turn it over to you amy perfect thank you jeff and uh thank you enterprise help for inviting me to be part of today's webinar um you know it's very interesting as we have moved through the various stages of the coven 19 pandemic and our focus has shifted for necessary and obvious reasons as we've moved through the pandemic from focusing on excluding or removing our employees from the workplace to considerations regarding returning our employees to the workplace uh antibody testing covid19 testing you know all of those issues relating to employees and now moving to what i think is the most exciting phase of all of those phases which is vaccinations and um you know the legal issues associated and with and that employers are having to consider uh concerning uh coven 19 vaccinations and the policies that you want to put in place for your employees a quick disclaimer here uh that the information i'm providing today is just that it's general information and shouldn't be construed as legal advice you know many of these issues that i'm going to be walking through here quickly in the next 15 minutes are things that uh you know your organizations hopefully are consulting uh with your legal team on and if not should be because there are some pretty complicated considerations to walk through as it relates to the legal issues associated with coven 19 vaccinations and your employees next slide please all right covered 19 vaccinations in the workplace really two big questions here for employers which are can we and should we um in in some ways you know one is a legal question and the other is more of a a business question um and and in some ways the the legal question may be easier than the business question um and as you'll you'll see this morning or this afternoon uh depending on where you are you know our panelists today are going to be bringing different perspectives as to those two very different questions which perhaps have very different answers so just running through you know some of the questions that we should be asking as employers as organizations considering cover 19 vaccinations who are we having perform the vaccinations is it us the employer is it a third party we're contracting with or a completely unrelated third party such as the state or a county uh who would we require we require to become vaccinated out of our workforce are we going to require require it for every employee or only certain positions uh next what action can and will we take if an employee refuses to be vaccinated you know if we're going to put in place a mandatory vaccination policy are we really uh committing to making the decision to terminate employees who refuse to become vaccinated next how will our approach be different now and later as i've advised employers throughout covid this is an ever-changing set of circumstances and employers must be nimble with respect to their policies as it relates to cova so while an organization may decide you know presently we're not going to require vaccinations it could be that at some point down the road your organization is going to change that approach next what are the legal risks to mandating and encouraging employees to become vaccinated we'll talk through some of those in a few minutes what safety precautions will remain for our organization post-vaccination including um you know if we have employees who refuse to be vaccinated are we going to allow them back into the workplace and what will uh the rules be uh that are in place for those employees and others will we offer incentives and what are the legal uh limits that might come into play on offering those incentives and then finally i've been getting the question you know should we get waivers signed by employees i get that question both in the context of uh waiving any harm they may uh receive or adverse adverse um reaction to becoming vaccinated uh and also employees who refuse to be vaccinated and then go back into the workplace next slide please okay so let's spend some time talking about this first question of can we require vaccinations uh generally as as most people have probably read or heard by now generally the answer is yes with some caveats there are two main legal objections that an employee will likely raise to a mandatory vaccination policy or even and one that's strongly encouraged and those are based on religion under title vii of the civil rights act and disability under the americans with disabilities act in addition public employers you know state county city public employers have added considerations under the u. s constitution when it comes to requiring vaccinations that they also must must walk through and consider whether a mandatory vaccination policy is permissible next slide let's talk about the religious accommodation consideration so i said as i said one of the reasons an employee may refuse to become vaccinated is for religious reasons uh title vii of the civil rights act says employers can't discriminate against employees based on religion and as a result requires that employers must accommodate their the sincerely held religious beliefs of their employees so an employee may say i'm refusing to receive the coven 19 vaccine due to my sincerely held religious beliefs at which point the employer and the employee must consider okay what reasonable accommodation might be available to accommodate this employee the limitation under time under title seven for religious discrimination is would that reasonable accommodation create an undue hardship which for purposes of religious discrimination is defined as more than a de minimis cost or burden on the employer it's actually a pretty easy standard uh for an employer to meet when we're talking about religious accommodations um and and uh and uh accommodations for for uh covet 19 vaccinations documentation what a combination is needed and why that's the information employer wants to get documented from its employee another question on this that i commonly get though is what if the employer has bona fide doubts about whether that employee truly holds uh you know sincerely holds those religious beliefs uh the eeoc has said basically you know you should assume that they are sincerely held however there are circumstances where you may have good reason to question and require further information from an employee i would encourage you that if you have a situation like that where you are questioning an employee sincerely held religious beliefs reach out to legal counsel and walk through that analysis and whether you should be requesting additional information from that employee or not next slide please so in addition to religious accommodation considerations we have disability accommodation considerations so this is where an employee is refusing to be vaccinated for a medical reason right due to an underlying disability and what employers want to request here is documentation from a health care provider indicating that that employee should be excused from the vaccination requirement because of a medical necessity again like with the religious accommodations that employer needs to engage in the interactive process to try to find a potential reasonable accommodation along these lines eeoc has said to employers look to cdc and osha guidance for ideas about ways to accommodate that employee maybe it's working from home maybe it's allowing that employee to work in an area where they won't be around other employees so employers have to consider is there an effective accommodation available to this employee that wouldn't create an undue hardship on the employer uh the next critical question really is let's say that there there is no um reasonable accommodation that really would permit a safe situation but the final question the employer needs to ask there is you know is there any way to avoid that employee posing a direct threat to the health or safety of others or themselves if they were to return to the workplace as we know the eeoc has already said that kova 19 presents a direct threat so this may give employers an argument if they really want to push it that you know there there is no reasonable accommodation due to the direct threat involved and based on that employee specific job next slide please other legal considerations of mandatory policies i would say if you have a union in your workplace you're going to want to check that collective bargaining agreement to see what the implications would be of a mandatory vaccination policy as i said earlier public employers face additional challenges under the u.

s constitution to mandatory vaccination policies uh there are also risks associated if for saying let's say an employee has an adverse reaction to a vaccination will they then sue the employer for making the vaccination mandatory my my quick response on that would be that that claim would likely be a workers compensation claim and in fact some states are revising their workers compensation statutes to provide immunity for employers in those situations and also consider whether you have state legislation that prohibits a mandate there is such a uh a bill being proposed in indiana that would prohibit employers from requiring a coven 19 vaccination or really any vaccination really if the employee just decides they don't want to get it so so be sure to check state legislation in all areas where you have employees on this issue of mandatory vaccinations next slide please employers also have additional legal considerations under the ada agena so if you if an employer mandates and and provides the vaccination meaning the employer is going to administer it or contract with a third party to administer it that employer is through the screening questions that would be asked prior to the vaccine being administered that employer is making medical inquiries and under the ada there are limits when an employer can make medical inquiries of its employees they must be related and consistent with business necessity so if if an employer is going to administer the vaccine or contract with a third party to administer the vaccine and collect this information that employer is going to have to be able to show meet that direct threat standard that i mentioned earlier you would have to be able to establish that that employee would pose a direct threat to this health or safety of themselves or others if they were not to become vaccinated so just additional considerations to keep in mind there if if you the employer are administering the vaccine or contracting with the third party next screen please next question do we want to require copin 19 vaccinations i know others on the panel will be digging a little deeper into this issue but um you know it things that i'm reading about and hearing uh about for my clients include employee morale will our employees feel like we're infringing upon their personal liberties if we mandate vaccinations also staffing shortages are we going to lose employees to the point that there's going to be a disruption to our organization's operations because we're mandating vaccinations also the effectiveness of a mandate given the religious exemption issue and the disability exemption issue i mentioned earlier we all know that some remain uncomfortable opposed some are already anxious most are already anxious as a result of the coven 19 pandemic and by mandating vaccinations are we increasing them anxiety next what are most employers doing i would say that most are not currently mandating but as i said most things related to covenant 19 are all things related to code 19 are subject to change most are currently encouraging but are not currently mandating next slide please ways to encourage vaccinations which i know we'll hear about from others including dean but thinking about leadership your leadership setting an example or providing stories about vaccinations their own personal story next access so informing your employees how they can sign up to become vaccinated educating employees through information through credible information about the vaccines available not information they might be getting uh through social media and other uh resources that may not be credible and then finally the issue of offering incentives which i can move to the next slide we'll dig in a little bit deeper on incentives you know possible incentives for employees could be you know offering time off paid time off to become vaccinated uh some employers are paying bonuses and providing gift cards uh to employees who agree to become vaccinated and move to the next slide there are some legal issues however that employers need to consider if they are offering vaccine incentives again it depends on whether that vaccine is being administered by the employer or that employer's third party who they've contracted with if so there are some ada considerations that may limit the incentive that can be offered to that employee however if the vaccine is being administered by a non-contracted third party then there are not these limits on the incentives that would be imposed by the ada next slide please finally requiring waivers from employees who refuse the vaccine um there are certainly questions as to the enforceability of those waivers whether it's whether under public policy arguments as i said if an employee were to have such a claim it would probably be a workers compensation claim and that might be the employee's sole remedy and the other thing about requiring waivers is that employers cannot waive their legal obligation to provide a safe workplace under osha and so really employers have to think about this issue from two perspectives one you know can you create a safe workplace without mandatory vaccinations and how will you do so and also what are you going to do to create a safe workplace without mandatory uh vaccinations uh so you know thinking from both perspectives of you know if we don't require it or if we do uh how are we going to create that safe workplace for our employees which is our our continuing obligation and what are our policies going to be uh regarding social distancing masks etc remote work going forward despite the avail availability of the vaccines and i believe that that is uh my final uh slide for now so i will turn things back over to jeff okay great thanks amy next up is dean frieders and dean is general counsel with work health solutions and they're a rapidly growing organization that offers employers a choice of mobile nearsight or on-site employee health services and they've actually been using our technology to provide covid related services to a wide range of corporate health system and state government clients and dean is going to talk a little bit about the practical workplace rollout of the coveted vaccination program including bargaining unit discussions and implications for worksite medical programs so take it away dean great so as jeff indicated uh work health solutions were we provide occupational health services in all formats we have some sites where we have personnel on site working within a production manufacturing distribution facility office facility offering a full range of occupational health solutions we have some locations where we are near site where we'll have a physical clinic located near a client location and they send their personnel to our to our office to uh receive treatment and then some locations where we do mobile services where we will deploy a team out to a site to do osha screenings or other occupational health related services for short-term deployments so let's jump in the wayback machine here where were you when you first talked about covet in the workplace or you first realized how bad it was going to get one of the unique things about work health solutions is that all of our personnel came from the private sector we all came from your position as clients so back in january february 2020 i was a city manager in illinois i remember hearing about kovitt on the news and we had a staff meeting our weekly staff meeting and we sat down and talked about it we thought we were way ahead of the curve we ordered some rubber gloves and some lysol and thought we were ready for anything by march 20th i remember sitting at my desk and turning on the news and hearing governor cuomo shut down the state of new york and my wife asked me to pick up some groceries on the way home and i went to target and the shelves were bare that was the first time i had some idea of how bad things were going to go although i had not a fully uh conceived idea i don't think any of us could have imagined looking at that timeline january 7th covet was identified as a new novel virus first case reported in the u. s marched first it was declared a global pandemic ten days later we started seeing states shut down within a few days after that moving forward to today nearly half a million deaths nearly 30 million cases so looking back let's say that you could send yourself a tweet back to february 1st 2020 yourself and what would you tell yourself in 280 characters what would you say if you could give yourself a warning about what was to come what supplies would you tell yourself to order what prep would you do what business strategies would you implement perhaps most tellingly i think in retrospect many of us would have started toilet paper distribution companies and we would have retired wealthy by now so what would you name your toilet paper distribution company i'm going to tell you what i would tweet myself if i could go back in time in just a couple minutes here what has the impact of covet been on our business we can roll right forward here the impact of society again 30 million cases close to half a million deaths massive lost productivity this has been a national an international incident worldwide obviously but when we look at our country every state has had shutdowns of some sort most of them implemented over a roughly 45 day window march april of 2020 and i'm going to today what are the long-term impacts on business what will those impacts be are we going to go back to having in-person meetings are we going to be wearing masks forever what are we doing for standardization what are we doing for occupational health what are or what should the occupational health impacts be the society for human resource management estimated covet related costs to u. s domestic businesses at roughly 1.

3 trillion dollars that estimate was from april of 2020 roughly two months into the pandemic those costs are lost time lost productivity sick leave medical costs lost opportunity you're going to notice i jumped over health insurance unemployment and workers comp because those are costs that we're not going to know for years the long-term implications of the pandemic are things we're not going to understand for years to come so can we make vaccination mandatory amy talks very eloquently about that yes we probably can should we make it mandatory well we need to look at the site at the industry at personnel specific considerations we're going to talk about why more employers should consider mandating or having a highly effective volunteer vaccination process and also look at the impact on businesses our cold vaccines safe we have done tens of thousands of vaccinations we've been doing vaccinations since mid-december it's an incredibly low risk of serious complications there's a minor risk of discomfort with the second injection typically but minor body ache muscular pain type things are they effective moderna and pfizer both around 94 95 effective you may have been hearing in the news lately about the new single-dose johnson and johnson vaccine it's about 66 to 72 percent effective depending depending on which study you're looking at and we're hoping to see more data and the efficacy of that in the days to come the johnson and johnson vaccine can be stored at regular refrigerator temperatures as compared to pfizer which has to be stored at about negative 80 degrees celsius and moderna which has to be sorted about negative 20 degrees celsius so are they safe yes by and large they are safe are they effective they're showing pretty good effectiveness when you look at how serious this illness is realistically isn't covet almost over hasn't the curve flattened why are we caring about vaccines now isn't this something from 2020 well there are new strains of covid being discovered every week there are some experts that are saying this is covid19 get ready for covid 21 covet 24 other strains coming down the pipeline moreover vaccines are not 100 effective and for her immunity to work we need to have about a 95 percent public vaccination rate herd immunity is the concept that enough people have been vaccinated that even if one person gets ill who hasn't been vaccinated they won't be able to spread the disease we have to get to 95 public vaccination before that will truly be effective the secondary and tertiary complications from covet are severe some people have covet and are asymptomatic and don't realize they have it and some people are developing lifelong complications or fatal complications that we don't have an advanced understanding of the other reason that we need to think about covet treatment is because of money frankly we're businesses and the impact that covet is having on our productivity in our workforce is dire so how do we prevent outbreaks we wear masks we sanitize we social distance candidly vaccination is the most effective way of preventing outbreaks of reducing absences reducing employee downtime increasing productivity this is the time to focus on occupational health if i was sending myself a tweet back to february of 2020 when i was working as a manager of a large and productive organization i i wouldn't have said order masks i wouldn't have said order more lysol i would have said look at your occupational health programs why is that so critical now well one of the reasons is because we need to address the latent high risk health issues that our employees have obesity heart disease diabetes these are all things that put you at a far greater risk for covid related complications and the secondary and tertiary complications that we just talked about moreover they're the same things that put your employees at a higher risk of every other type of health issue their co-morbidities for many other types of disease and if you can address them and have a healthier workforce you can be more resilient and more profitable this is the time to communicate the importance of health issues in the workplace employees are listening if you can enhance your employee health you can enhance their productivity and their happiness and that will simply make you more money we have health programs that have demonstrated a 260 percent return on investment just based on avoiding preventable illness and injury there's never a bad time to look at occupational health this just happens to be a really fantastic time to look at it so what does that practical workforce roll out look like we'll jump right into the next slide here it is critical that before you go to your employees and say we're going to have vaccinations whether mandatory or voluntary you have to get them to think about it you have to educate share factual information on vaccination efficacy and availability you have to use objective recognizable third-party sources of credible information centers for disease control fda you have to build consensus and understanding with employees before you start talking about any on-site programs move to engagement ask what their questions are find out what the answers are and provide responses follow up communicate with your employees via posters via email pamphlets for distribution whatever communication venues your employees are using you need to use those as well hold webinars like this with your employees and engage leverage trusted medical or clinical partners to engage with your employees at locations that we're providing on-site services we are a core part of the employer outreach reaching out to employees providing factual information and building understanding and consensus upon which a reasonable and well-founded program can be started so jumping back to july of 2020 we were asked to conduct on-site covet testing in a prison facility with five bargaining units the facility or management said we needed to start testing on tuesday we talked about doing some employee outreach and engagement and they said no we just have to launch testing as quickly as possible we showed up on tuesday the immediate response of employees was grievances grieving from every bargaining unit consternation anger shouting led to a lot of meetings a lot of engagement a lot of information a lot of sharing of data it led to a lot of employee and bargaining unit consternation and we had to overcome a lot of obstacles before we got to a point where employees could even begin to support the program and that was just coveted testing not vaccination so we go through our education engagement process what's next we have a clearly defined written policy on vaccination parameters who is it available for if possible everyone you may have to phase in your vaccination depending on the types of workers that you employ who is or can be exempt from the program amy talked about that in detail when and where is it offered and who pays our recommendation eliminate as many barriers as possible offer vaccination on site during work paid by the employer we have some innovative programs were partnering with public health authorities and offering on-site vaccination using a public health supply it's the best way to ensure a healthy workforce so what are the implications for occupational health programs overall how do we plan for kovid 21 the next pandemic is coming there was sars in 2002 h1n1 in 2009 mers in 2012 ebola in 2014 zika in 2015 dengue fever in 2016 and kovit in 2020. if you're an international company you were affected by each one of those pandemics in some fashion if you're a domestic company kovit may be your first experience with them but let's talk to about what the wall street journal has said on the pandemic the rapid and global spread of the deadly new coronavirus caught households business leaders investors and policy makers off guard but health experts and economists who study pandemics say it should not have come as a surprise at all epidemics of infectious disease have become a regular part of the global landscape in the past quarter century thanks in part to economic trends including urbanization globalization and increased human consumption of animal proteins as society becomes more prosperous these experts say the public needs to prepare for more pandemics they add there will be more pandemics to come having a more resilient healthier workforce is a workforce that is more resistant to the next pandemic and more resistant to the secondary and tertiary complications that come with it having an infectious disease plan in place is critical having a health provider on-site nearsight or mobile that can help you respond quickly to all sorts of occupational health concerns is critical these produce happier and healthier employees these produce a healthier bottom line for your company so what are you doing to prepare what would my tweet tell me to do back in february of 2020 i'd be looking at my what we call our iipp my bloodborne pathogen program my vaccinations my airborne infectious disease plan my cleaning and standardization plans i'd go back and look at our oc health wellness and surveillance programs are we doing biometric evaluations are we doing blood tests and physical assessments are we implementing steps to support our employees who have latent health issues that we can work with work on i would look at our electronic health record so all of the data in the world on your employees health is no good if you can't capture it and monitor it the use of something like enterprise health that allows you to capture that data securely restrict access to it to personnel who have a business need to know and engage in trend monitoring so you can identify potential occupational health issues before they become your workplace pandemic these are critical steps they also allow you to evaluate your key performance indicators and return an investment for your act health program what does occupational health mean to you is the pre-employment screening just a prerequisite are you just checking a box yep that was done or are you really looking at your employees to determine their risk for injury or illness and implementing a responsive program to enhance their health that's where businesses need to be going so what should every employer do right now you should be evaluating the potential for an on-site vaccination program if you want to have a progressive response to the workforce to the occupational health considerations that still exist with covid19 in the first quarter of 2021 and will exist for the months to come you should also evaluate your overall occupational health programs on-site nearsighter mobile services as they may be best configured for your unique needs and you should evaluate the potential for changes in the intensity of the service that you're currently offering as you make those changes consider your messaging consider your tone consider the employee outreach and education you engage in we're working with an employer right now who started their campaign on occupational health with a message that says because we care because we care about you we are investing in your health and wellness it's a great message and it's one that we love to share so the role of your act health provider is not to just check a box yep we did the the pre-employment screening and they can lift 50 pounds the role is to enhance your employee health reduce the frequency and severity of injuries reduce and mitigate the effects of injuries and make your workforce more productive and profitable through a comprehensive health approach you can be better prepared for covid for the next pandemic or for any challenges your business faces with happier and healthier employees this is an opportunity to rethink your approach to occupational health and the way that you think about the well-being of each and every one of your employees this is your opportunity to reset and be prepared so that when the next covet rolls around you have the toolbox you need to be able to respond immediately and thank you so much jeff for the opportunity to speak today thank you dean great job okay uh well now that we've heard a little bit about the legal issues and and i think uh dean did a great job of sort of you know talking about uh you know the importance of of having a good occupational and employee health program uh and and now we're gonna hear uh from from an employer uh who's uh dealing more with some of the logistical challenges of setting up a worksite covid vaccination program and we're actually joined today by two panelists from philip 66 so we have tim ray cobb who's the director of medical compliance and policy and amanda guilfoyle who's an analyst in the hr and business solutions group and tim and amanda have been preparing for the administration of covid vaccines for not only phillips 66 employees but also their family members so tim and amanda please take it away good morning thank you jeff my name is tim raycob i'm a physician assistant with philip 66 and um i'd like to give a little background on where philip started back on january 20th of um 2020. this was over a year ago phillips realized that there was a highly infectious virus going through wuhan china and our health services and crisis management group got together and started [Music] developing a contingency plan for what would happen if this ever came to the u.

s which unfortunately occurred in february of 2020. in early march of 2020 we updated our emergency response plans to include a uh we modified our pandemic flu plan to a pandemic coronavirus plan and we started doing uh covet antibody testing in april of 2020 to ensure that our employees were safe and we try to mitigate transmission of kobig throughout our workplace so in october of 2020 our group determined that there was going to be a high probability that corporations would likely be asked to participate in vaccination programs for covet 19 so we started developing a plan to partner with the different state health agencies to determine what sites would be eligible for enrollment and started determining what resources would be needed and what logistical challenges that we would uh face as we anticipate on becoming vaccination sites so i'm going to give more of the micro picture of what we've developed in bartersville oklahoma which is where amanda and i are based out of and i think amanda's going to give more of the macro picture of where we are corporate wide in our response planning so one of the things that we have to determine is where are we going to locate our vaccination site so our bartersville campus we actually have two different campuses in one's a research center one's a corporate headquarters site we have approximately uh 1600 people in bartlesville but we also support a joint venture in bartlesville called chevron phillips chemicals which has an additional 300 people so we support about 1900 people in the bartosville area so we looked at our two large buildings and we realized that those would be unsuitable because they have restricted access and with covid being transmitted we locked down access to those two sites to prevent anyone other than philips employees and contractors from accessing our buildings so we realized we needed an external facility that would be easily accessible to employees contractors and our company determined that we would extend our vaccination program to eligible household members so as we looked at our spaces we realized we had a very large print center that had been decommissioned approximately three years ago that had 50 000 feet of reusable space the access to the building could be programmed to allow anybody into that building so we took a look at it and determined that it would meet our it would be suitable for our needs so as we looked at the building we realized there'd be three main areas that we had to develop resources for we had a intake area where people would have to register and be enrolled into enterprise health we'd have to have a vaccination station that we manned by people who were certified to give vaccines and then we had to have a monitoring area um so that we could monitor the individuals for 15 or 30 minutes depending on their health status and if anyone did have a adverse reaction we also had to have a separate treatment area so that we could isolate those individuals and not have them treated in a large monitoring area filled with other people so what we've determined was that we'd have to have a area where we could have a high flow of individuals we estimated that once we geared up we would have to be able to process approximately 400 people a day for our corporate facility and we would need on average approximately 20 people per vaccination clinic in order to operate the fish at the efficiency that we uh wanted so as we looked at our workflow we realized we needed three intake stations that um people would have access to uh computers to enroll people into the uh enterprise and then we would need a minimum of three vaccination stations each station would demand by a vaccinator and a medical scribe to complete the immunization card we'd have two people who were designated as rovers to circulate around provide supplies obtain or get vaccine out of storage up vaccine assist as needed and then five individuals in the monitoring area two for check-in and monitoring time and three to monitor the individuals in the holding area and provide emergency response and then we also had one individual at the uh prior to intake who was doing temperature monitoring on every individual coming into the building and then we had two security individuals to maintain efficient traffic and patient flow so then we have to consider what was going to be vaccine availability for us and obviously that's entirely dependent on the oklahoma state health department how much they received from the manufacturers and federal governments [Music] we also understood that we'd be restricted to vaccinations in alignment with the state regarding what the current tier status was and because we are dependent on the state it's kind of a stop and go process we receive vaccine we administer it and then we have a waiting period as we await more vaccine or the state moves on to the next tier and unfortunately in oklahoma we really cannot request vaccine until our current supply has been expended so there's always a time lapse between um expending that vaccine and obtaining new vaccine next slide and then one of the things we have to overcome was population resistance to the vaccine so uh amanda i think it will probably address that hey tim i think we've lost your audio hey amanda are you out there i am we just received a message from tim that he lost internet connection okay well maybe maybe you can you can pinch it here and finish his part out and then do yours sure so for population resistance um like you said we got about a 79 survey response rate that has gone up in the last couple of weeks with some of our initiatives around uh teaching moments specific to the vaccine and then 78 requested a vaccine for themselves and their household members so of those that are responding we do have a pretty good response rate of those opting in um philip 66 approach was that we this is an opt-in um approach and if you opted out from the in the initial wave of offerings then you could opt in at a later time so 21 of our overall population group did not respond or they declined the opportunity to receive the vaccine completely at this time so reasons for declining the vaccine it came from a variety of reasons generally i just don't take vaccines of any type so you know those that are most resistant to vaccinations such as your annual flu vaccine and that type of thing i think that resistance was pre expected and then the vaccine is just too new we don't know what the long-term risks are for those vaccines so we've heard a lot of that there's some conspiracy theorists out there so we've heard some of that not too much from our philip 66 employees but that is out there and then the state response issues tim are you back yeah i'm back okay i just jumped in where i had state response issues got kicked off for some reason so a lot of people are concerned about the state response you know we've had some issues where people in our area have been scheduled and then vaccines not available they've had their appointments canceled been rescheduled been cancelled and so when we reach out to people who have had multiple episodes of inconsistency with the state they're a little uh disinclined to participate in our program and then there's also some questions about um if they need evidence that they've been vaccinated and they've lost their vaccination card how are they going to obtain information from the state so part of the issues is that there's lagging communications with the state health department i. t and the availability of obtaining vaccination reports and then the last reason is people are just because the new vaccine they're just waiting and observing to see what happens with the vaccine they're not dead set against getting the vaccine but they are more comfortable just waiting and observing other people's reactions and responses and waiting to see if there's going to be development of a general herd immunity and they may not have to get vaccine then and then there's the storage and handling um logistics issues you know dean brought up earlier that each vaccine has different storage uh requirements so it's kind of ironic that the state doesn't seem to have a real good idea of what the handling capabilities of our sites in oklahoma have for example here in bartlesville we do have the capability for ultra cold storage along with standard storage um so they sent us the modern vaccine um we have another site in ponca city which is about 70 miles from us that's a refinery they do not have ultra cold storage capability but they were sent a pfizer vaccine for some reason so they had to basically use vaccine immediately upon receipt because they didn't have storage capability whereas if we had received visor we could have kept it in a frozen state until we did need it um and the other thing is that because we were having to shuttle back and forth from our main clinic to a satellite building we had to develop storage capability in the satellite building to store vaccine on the days we had vaccination clinic and then the last issue we had to address was we did not get adequate supplies from the state or moderna as were promised we were told that for every hundred vaccines we would receive 10 percent more supplies than vaccine that did not actually occur so we ended up having to procure certain supplies on our own and then the final thing was after we overcame and developed plans for the previous issues we have to determine how are we going to utilize enterprise since it is our emr so we have to work closely with mie and enterprise regarding communication scheduling because virtually every state requires immunization information system data input on a 24-hour notice with the current system we're currently doing a dual point data input where we have to enter everything into enterprise and then turn around and enter everything into the state uh iis so we are working on developing uh interfaces for each state iis however each state has a different is standard for example oklahoma uses hl7 real-time file transfer whereas texas uses ftp protocols which are unidirectional don't give us a very good error feedback if there's any data that's missing and then as jeff brought up um we have to work with mie and enterprise on adapting some of the reports that are available in enterprise and modifying them for uh kovit 19 metrics and reporting that's what i have on logistics and then amanda will take up her portion i believe regarding uh how we integrated enterprise our system yeah thanks tim so i am a business analyst an i.

t analyst and i've worked very closely with health services over the last six years we integrated with enterprise health a little over a year ago i guess it'll be two years in july and i first want to start by thanking jeff and emily your teams are amazing um i i haven't worked with anyone in enterprise health it just doesn't really amaze me um so really great response rates um really great brainstorming how can we make this happen folks and love to be part of that team as we rolled this out the first thing that we felt we needed to do is develop an opt-in survey and we felt like we needed to do this um as a as an approach to not only understand what employees household members and contractors may be interested in receiving the cova 19 vaccine but also collect enough data so that we're able to prioritize um the rollout of that vaccine because we we noticed very early on cdc had some guidelines on how the vaccine was going to be distributed and states were following suit and i'm glad we took that approach pretty early on because that has indeed been one of the biggest challenges that we have is at some points we have vaccine on hand but we don't have a large population that fit the category of the rollout prioritization or the stages that the state is is requiring us to adhere to so in that opt-in survey we did roll it out to employees and what we call internal contractors so those contractors that have um an actual contractor portal that we service and they can log in just like an employee can in that survey we collected age health conditions and high risk employment information on primarily those household members so an employee opted in they also have the option to list their household members their names their ages and then we listed the cdc health conditions that make you high risk for cova complications and also the list of employment categories that would put you in a higher prioritization for receiving the vaccine so we also use the enterprise health portals to provide our documentation so the emergency authorization documents our legal department also creates some internal data privacy statements that they wanted us to provide to all those that would be immunized immunized and then we also solicit the completion of our consent form for the kova 19 vaccine on our portal systems and then we're also previously we did not have the schedule capability on our portals for employee self-service or contractor self-service but we did opt in for that so that employees can schedule or change their vaccine appointments as needed just because of the high volume i know a lot of folks are already using that for flu vaccines so we followed suit in that for the cova vaccine um and then for employees and and internal contractors like i said they have that self-service schedule opportunity but for household members and external contractors um we opted in for a a portal system that would create a a temporary chart essentially an enterprise health so they can log in they can see all of those required documents that we provided to the internal contractors and employees and then they can also complete their consent form so everything stays electronic we're not doing anything on paper so this is just an overview of what the process workflow looks like so we've we run the opt-in survey report within enterprise health that gives us feedback on who completed the survey who their household members are and again those those priority groups that help us determine who's going to get the vaccine first and then we receive information from tim via or from the health department via tim on how much vaccine we're going to have available and when we expect it to come in and then we start setting up our appointments we make sure that we have the staff availability like you said it takes about 20 people to run the process and then we start booking those appointments we then use that same opt-in survey report in an excel format and we put that into our import template and we enroll those employees via an import that are on our priority listing for the upcoming vaccine clinic when that occurs we already have it in place um where the the employee and the contract will receive a notification they've been enrolled in a program they have items out on their portal to complete um and they can schedule their appointments there and the first few rounds we've we've done just over 500 doses in bartlesville and like tim was describing earlier of those we did do a lot of um scheduling those folks and just giving them a date and a time to show up rather than giving them um a a choice and when they're scheduled just so that we had a little more control over the first few clinics the check-in process is probably the most time-consuming piece so as they approach the doors their temperature is taken and they are directed to a check-in person we have three to four check-in people depending on how many we're doing that day that check-in person is taking their name looking them up in enterprise health verifying that their consent form was completed if the patient had not completed their consent for prior to coming in we do have ipads and laptops as well as qr codes to the portal systems available so they could um scan that with their personal mobile devices as well and complete those requirements prior to getting vaccinated we ensure that no changes have occurred since they completed their consent form and we did combine our consent form and the health assessment questionnaire into one electronic document within enterprise health so we are verifying that that they are eligible for to receive the vaccination at the time of check-ins if they have any questions we have medical personnel available for private consult to make sure that they do indeed qualify to receive the vaccination and all their questions are answered prior to we then document an enterprise health that they are receiving the vaccination so we complete the administrative process and then we send them down the hall to actually get the receive the vaccination after they're vaccinated um they go to the monitoring station where they're monitored for 15 or 30 minutes depending on how they answered their health assessment and and then we attempt to schedule everyone for their second dose before they leave leave the area at the end of the day we do have it in a day ejection report that we run we've been trying here the last few clinics that we've run doing this throughout the day and it has worked out well and we do this because right now we're manually putting in the oklahoma state registry all the injections that are done throughout the day so we do have that injection report that has the data points that we need and it's it's essentially a data transfer from enterprise health to the state registry which is manual today but should be done via hl7 file in the next few weeks so here's some of our lessons learned i kind of mentioned the qr codes for each of the portals um that's just been an easy way for people to complete their consent forms that didn't come in that didn't complete it prior to coming in we've had a pretty low rate of that most people are completing those before coming in but that keeps them on their own mobile device rather than sharing devices we've learned that a one-to-one or even a two-to-one ratio between check-in person and vaccinator is good because the check-in process really is the longest process between that and vaccinating the time from them walking in the door to check in as long as they've done their their work on completing the consent form prior to coming in all the way to the monitoring station is about four minutes per person so it's a pretty quick process we can get about four people in every five minutes so we schedule four people at one time and then for every five minutes and that's with two to three vaccinators and then three to four check-in um people and then at the end of each hour we do put a 10-minute buffer in just for catch-up in case um in case we did have an influx of people coming in that hadn't completed their consent form or give bathroom breaks to our vaccinators or our admin staff that type of thing uh really we we have we started out with 15 minutes there we've discovered pretty early on that we really only needed about 10 minutes and this flow is very giving we don't um we we have a lot of flexibility and some breathing room with this schedule so it's worked out really well for us jeff i will turn it over to you that's really all that i had okay great thank you tim and amanda as as well as dean and amy great content we've got about 15 minutes left for uh for q a and again i would remind you that you can pose questions using either the chat or q a feature in webex and i know emily mccomb from our shop is going to monitor those and i'll go ahead and get the get things rolling um with with a couple of questions um you know it it sounds like certainly phillips 66 but you know amy and dean from what you guys said too that that most employers are kind of opting for uh you know not not making this mandatory but but voluntary and you know doing the the right kind of education and promotion uh you know to get people to uh to sign up to get the vaccine in those situations where it is voluntary you know how are you seeing that people are handling the people who do decline so i guess i'll start first with maybe with uh you know with tim and amanda you know what are your plans for that that 21 who either didn't respond or said hey we're you know i i i don't want the vaccine right now uh you know what what are your plans in terms of you know are those people you know going to work from home are they going to have to wear a mask like what what are what are some of the strategies that are being put in place uh there to you know to keep the workplace safe well we're still requiring masking regardless of whether or not you've been vaccinated and that's going to continue probably long term until cdc changes their recommendations and that's a discussion that um our executive leadership and crisis management and legal all having is ultimately you know whenever it is july august september as more of us get vaccinated what are the plans for how we're going to ensure the safety and protection of our employees and especially what is the process for um for the workflow and accommodation for individuals who elect not to be vaccinated so that still pretty much influx uh dean or amy what are you what are you guys seeing among your employer clients hey this is dean uh so we are seeing employers that are pivoting and trying to engage directly with those employees that are not participating in the vaccination program in some of the facilities we work in employers are mandating it those tend to be a lot of state facilities but in private settings where there are employees that are not participating one of the kind of novel approaches we see with regard to covet that we haven't seen before with you know flu vaccinations and other similar programs is direct employee engagement reaching out to the employees that are declining offering them information and trying to understand what the concerns or objections are by and large those efforts have been pretty remarkably successful so we're seeing pretty high vaccine uptake rates at the locations that were engaged in vaccination right now so that's encouraging yeah this is amy i'll jump in here quickly as well you know i think that one thing that may happen over time just as we saw with employee reactions to wearing masks right i think we could see attitudes changing regarding vaccination you know once people really start seeing the widespread benefit and get more information and like dean said um you know direct uh efforts to reach out to those individuals who are you know currently refusing to become vaccinated you know i will say that once one thing that i've seen with employers that are mandating vaccinations is that they tend to get a lot more uh objections based on medical reasons and actually more commonly religious based objections uh which you know then become a lot more difficult to to change over time right so um you know if somebody has you know expresses a religious objection to receiving the vaccine when it when it's mandatory they may be less likely to change their mind versus um you know employer who is strongly encouraging vaccinations and somebody's just not ready but yet then may change their mind after additional information education you know that sort of thing okay great thank you emily i believe we have a a couple of questions from the attendees we sure do can you hear me okay yes great so the first one is a quick one that i'll actually answer um amy asked what software the p66 team is using for their health portal and that is the employee health portal that is a part of enterprise health um the next question is for the p66 team um the question comes from sandra and she asks did you use a third party to do the actual vaccine administration or did your own medical staff do that on site our own medical staff did that along with our emergency response team uh state of oklahoma authorized um uh emergency response personnel to be trained and certified as vaccinators so we have 45 people in our two campuses who are on the emergency response team and we solicit volunteers train them to become vaccinators so everything is kept in-house and organic we also are refined rates we have 13 reply or 13 sites in the u. s eight of them are going to be vaccinating on-site and they will be using their organic uh medical group to do vaccinations on site great thanks tim um next question um again i'll answer because it's just really quick richard asked if we'll be getting a link to the materials and copy of the slides and jeff i believe the quick answer is yes that'll all be sent out and then posted on the website as well right yeah we'll we'll send it out to all the attendees it'll take us a couple days just to edit uh edit the the slides down and then we'll we'll actually send out a link to a video recording perfect and then another question um let me pull it up here sorry just had it there we go um also can we discuss direct threat a bit more how does this change and evolve with other hazard mitigations in the workplace examples workstations are spaced 6 feet apart and 95s etc comes from amy yeah and so um my response to that would be you know what the eeoc has most recently said in response to coven 19 vaccinations and direct threat is to follow cdc and osha guidance so um you know like like tim said you know if if uh the cdc is currently continuing to recommend you know certain social distancing currently continuing to recommend uh wearing masks currently recommending you know different disinfection protocols you know i i think you're pretty safe if you are following those and evaluating how somebody could pose a direct threat to another employee or a customer etc so i would rely on that osha and cdc guidance for um or running through that direct threat analysis and thinking about you know what measures you need to continue to keep in place to keep your employees safe okay any anything from dean or uh tim or amanda on that one yeah i would echo that i think the guidance out of just about every federal and state agency with respect to covet 19 has recognized the severity of the threat posed by the pandemic and i think it is very unlikely that we're going to see any governmental declarations that undermine that severity so i think most of it this is strongly in favor of the need for an efficacy of vaccination programs gotcha well i know um you know tim you you touched a little bit on the the fact that you you know obviously philip 66 operates in multiple states and and you know you've got sort of varying rules and regulations in different states and i i know dean and amy that you guys have clients uh you know in multiple locations as well and you know so you not only have sort of the original everything has been coordinated state by state with vaccination and now i know with the new administration there's an effort to kind of increase the federal role and and you know i i know in working with our clients you know that that the you know all the different guidance uh from all these different agencies um you know state and federal uh and in some cases even county and city you know the the rate of change and even the conflicting guidance can be kind of dizzying um you know what what are you guys seeing in terms of the way that that employers are are you know are handling you know all all of these uh varying and sometimes uh conflicting bits of guidance well certainly keeping us on our toes i mean you know between the different states and cdc um as revisions come along we're finding that we're having to modify our guidance to our uh employees contractors on a fairly frequent basis along with trying to communicate with the state on how it impacts our ability to vaccinate our employees for example cdc last week just moved essential infrastructure employees up into phase 1c i believe and the state of oklahoma still has them in phase 2 or tier 2. you