What factors have influenced vaccine hesitancy among some groups of workers? And is there anything employers can do to encourage uptake, which could make workplaces safer for all? Professor Sian Moore highlights the main findings from an academic study.
Covid-19 has laid bare the importance of workplace health and safety and offers the opportunity for the revitalisation of occupational health and safety following decades of deregulation.
The pandemic exposed the shortcomings of the Health and Safety Executive and its lack of resources. It also demonstrated the UK’s weak health and safety infrastructure, with an absence of health and safety committees and worker representation on issues that affect workers’ health and wellbeing. Where there were trade union health and safety representatives, they made a difference in ensuring the immediacy of employers’ responses to the pandemic, pressing for risk assessments, but also regulating implementation of measures at the workplace.
The workplace is a major site of Covid infection, as shown by the recent legal case launched by the relatives of those in care homes where hospital patients with coronavirus had been discharged, highlighting the dangers for care workers. Yet, research on Covid-19 has overlooked the importance of the workplace and its centrality to public health.
Frontline workers at increased risk
The experiences of the frontline workers who worked through the pandemic are instructive. The fact that these workers are disproportionately Black and minority ethnic went some way to explain the vulnerability of these communities to the virus. The initial lack of personal protective equipment (PPE) and impossibility of social distancing in health, social care, retail and food production meant that these workers were significantly exposed to the virus.
Crucially, the pandemic has revealed the importance of occupational sick pay in preventing infection. Research by the Centre for Research on Employment and Work at the University of Greenwich found that frontline workers had limited access to occupational sick pay and that statutory sick pay (SSP) was an inadequate replacement. Reliance on SSP inhibits compliance with guidance on self-isolation because they could not survive financially; they could not afford to take time off work. One residential care worker described herself as “a walking weapon”.
There were specific issues for agency and self-employed workers who had no access to employment rights and limited or no access to sick pay and independent representation. Migrant workers, often agency workers or contract cleaners, similarly lacked protection.
Privatisation and outsourcing also made a difference. Those not directly employed by the organisations they worked for were denied the same employment benefits as directly-employed colleagues, often in the same job. This included having no or limited access to sick pay or the ability to self-isolate, and disparities in access to PPE. Occupational segregation and contractual differences on the basis of race and ethnicity were often promoted by privatisation and outsourcing.
Migrant workers dependent on their employers to remain in the UK, often felt scared of losing their jobs and thus being open about Covid-19 symptoms, of turning down work and challenging employers. Those on zero hours contracts, dependent upon their employer for hours, were reluctant to raise health and safety issues, but also felt pressured to attend work in the context of staff shortages and absence.
The experiences of frontline workers have affected vaccine behaviour. A British Academy project based on a comparison between Oxford (England) and Manchester (New Hampshire, in the US) found that frontline workers felt that governments and employers had not offered them adequate protection from the virus and that they felt undervalued. Such perceptions informed their subsequent vaccine behaviour.
Undocumented migrant workers were discouraged from engaging with health services because of the “hostile environment for migrants”, including the “no recourse to public funds” in the UK (meaning that there is no access to free health provision). Where migrant workers were not documented there were fears about identification.
While Covid-19 had disproportionate impacts on Black and minority ethnic communities because they were more likely to work in the frontline, legacies of medical experimentation on Black populations, as well as existing experiences of racism in accessing health services, could affect vaccine behaviour. At the same time participants refuted what they felt was “the racialisation of vaccination”, referencing anti-vax protests by white populations supported by the right.
Conflict over vaccination
The threat or reality of mandatory vaccination led to some workers in both Oxford and Manchester leaving their jobs or being vaccinated in order to remain in work. In the US there has been more industrial conflict over vaccination, including the termination of municipal contracts in New York and protests by firefighters and police. Yet in the UK, social care workers reported that employers disregarded the earlier requirement for vaccination because of staff shortages.
In both the US and the UK, governments retreated from directly enforcing vaccination for workers, in particular health and care workers. In the US, vaccination was more politicised than in the UK and opposition to compulsory vaccination was associated with identification with the Republican Party. In the UK, vaccination was less politicised, but mistrust of the government and its record on Covid-19 was voiced. However, in both countries the labour market is a key factor in the move away from mandatory vaccination, namely severe staff shortages in health and social care that predated but were intensified during the pandemic.
Employers have used entitlement to occupational sick pay and health insurance as coercive mechanisms. In the UK, companies like Tesco and Sainsbury’s have removed the right to extra sick pay for workers affected by the virus with the danger that symptomatic workers will not be able to afford to stay away from work. The removal of requirements in the UK to self-isolate has raised further questions about non-qualification of low paid workers for sick pay, with implications for employment relations and longer-term occupational health and safety. Coercive policies withdrawing sick pay from appear particularly pernicious in a context where inadequate sick pay contributed to the spread of the virus.
Trust in management and perceptions of safety in the work environment both influence attitudes to vaccination. Employers and trade unions play key roles in occupational health and safety and ultimately public health. In the light of the current and future pandemics, workplace health and safety needs to be revisited and the importance of organisational sick pay reviewed.
The British Academy research was conducted by Professor Sian Moore, professor in Employment Relations and Human Resource Management at the Centre for Research on Employment and Work at the University of Greenwich; Professor Christina Clamp, professor of Sociology at the Center for Co-operatives & CED at the Southern New Hampshire University; Eklou R Amendah, assistant professor of Marketing at the University of Southern Maine; Dr Nigel Carter, research fellow at the Centre for Research on Employment and Work at the University of Greenwich; Dr Calvin Burns, senior lecturer in Occupational Psychology in the School of Human Sciences at the University of Greenwich and Wesley Martin, research assistant at the Southern New Hampshire University.