Employers Grapple With Fear, Uncertainty and Vaccine Mandates

September 16, 2021

Photo by Phil Roeder licensed under CC BY 2.0

President Biden is upping the pressure on businesses to mandate COVID-19 vaccines for their employees. We talk with a preschool owner wrestling with this decision, and a researcher with tips on how to make a mandate work.

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Dan Gorenstein: Fear has driven much of the conversation around workplace vaccine mandates.

Employers are afraid of having unvaccinated workers.

They’re also scared employees will quit if forced to get a shot.

The recent summer spike in COVID cases and deaths has amped up pressure on businesses to require vaccines, and then the president cranked it up one more notch last week. 

News clip: President Biden is taking off the gloves to get more Americans to roll up their sleeves.

News clip: Requiring businesses with at least 100 employees make COVID shots mandatory or offer weekly testing.

DG: We’re still waiting for more details, but the announcement itself is already influencing some employers.

Today, we hear from one business grappling with whether to mandate or not, and another that’s taken the plunge and made it to the other side. 

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein, and this is Tradeoffs.


DG: Lesia Daniel-Hollingshead has a simple goal.

Lesia Daniel-Hollingshead: I would love to be able to operate with a 100% vaccination rate for all of our employees.

DG: Lesia and her brother Walter co-own and operate Funtime Preschool and Afterschool in Clinton, Mississippi, a town of about 25,000 people just a short drive northwest of the state capital in Jackson.

Lesia and Walter are responsible for teaching, feeding, driving and keeping track of 400 kids ranging from just a few weeks to 11 years old.

She says ideally they would have around 88 employees sharing that work, but finding and keeping workers lately has been tough.

LDH: I think we’re 78. Well, except for one, she just quit. So we’re going to be 77 as of tomorrow.

DG: Only 55% of those employees are vaccinated, something that has caused Lesia a lot of headaches and heartache.

Just last week, an unvaccinated teacher told Lesia that her fiancé had tested positive for COVID.

LDH: So here I’ve got a teacher in a classroom with 12 2-year-olds, and so I’m exposing all 12 of these children to COVID right here, right now. And I can’t, I mean, what do I do?

DG: The only thing she could do — send the woman home, along with her two children who also are enrolled at Funtime. 

LDH: And so now they’ve  impacted a 3-year-old class and a 4-year-old class. So this is basically 60 children that have been exposed to COVID just like that.

DG: At 3:30 the next afternoon, the teacher called Lesia — she’d tested positive. That meant 12 of those 60 kids needed to be sent home immediately. 

LDH: Pick-up is going on. I’ve got 200 parents driving through. And I’m trying to get an email together to send to them that says, “You’ve got to come pick your children up now. They can’t come back for 10 days.” We have to submit a report to the health department. We have to document everything. If any of those children have symptoms, then we have to do a separate report for the health department. It’s a lot of paperwork that goes along with that.

DG: COVID is making every decision Lesia faces harder. She’s so stressed, she struggles sleeping — the same questions rolling around in her mind. 

LDH: What if something happens to one of these teachers that tested positive? I mean, I can’t even begin to fathom. And then I think what if one of my children contracts COVID? And then I’m living with, because your child was at my school, they’re in the hospital on a ventilator now. It’s, emotionally, it’s a lot to carry. It’s just very, very heavy.

DG: Lesia’s life, obviously, would be lighter if her whole staff got their COVID shots.

So, this summer the company offered extra paid time off to anyone who gets vaccinated and held all staff meetings, where Lesia explained why this was so important to her personally and for the health of the business. 

That helped boost the vaccination rate from 10% to 55%.

But so far, no mandate.

She’s scared. 

Scared of staff leaving.

LDH: Walter said, I don’t know how we could say, you have to be vaccinated to work here without losing, probably about 30% of our staff.

DG: Scared of making decisions she feels unqualified to make.

LDH: I haven’t been to medical school. I hardly understand it myself, and then I’m trying to make decisions that affect people’s lives.

DG: Scared of a worker getting sick from the vaccine.

LDH: If we knew that we could be 100% safe and not risk any health effects, then I would be very comfortable.

DG: Does the fear of that possibility, that one of your employees could be physically harmed by this vaccine, is that fear so great, Lesia, that you’re willing to risk people getting sick, kids getting sick, the business that you’ve been in for 20-plus years shutting down? Is that how big that fear is?

LDH: You’re very, very afraid that instituting a policy could potentially harm someone, and then you’re very, very afraid that not instituting a policy can harm someone. The fear just around everything is so huge, it’s hard to process, and it almost makes you feel a little paralyzed like I can’t move in any direction because I’m afraid that whichever direction I go in, it’s going to be wrong.

DG: My understanding is that the risk of being harmed by the vaccine is much smaller, I’m not saying it doesn’t exist, but it’s much smaller than the risk of getting COVID. I’m hearing you talk about this paralysis, but at the same time, it doesn’t feel like it’s equally weighted risk. Is that how you see it, though?

LDH: It feels a little different to me because I’m talking to my staff, and I’m hearing their personal stories, and so you don’t know these people you haven’t, you know, like you’re not in this building with them, and I don’t mean that to be negative. But like talking to them and having them sit in here and cry, it’s a very huge deal for them, and I feel like if I mandate something that then comes back and harms them, I just… [heavy sigh]

DG: Lesia feels stuck in this delta vice grip.

Until last week, she had ruled out a mandate, resigning herself to more stress-filled days and sleepless nights.

But she says President Biden’s speech felt like kind of like a wake-up call.

President Biden: This is not about freedom or personal choice.

LDH: This is the way that we can protect the population of our country. 

Biden: It’s about protecting yourself…

LDH: And you do that to protect yourself…

Biden: and those around you.

LDH: but you also do that to protect others around you. 

Biden: The people you work with, the people you care about, the people you love.

DG: They still need to talk it over more, but Lesia and her brother Walter are seriously considering requiring vaccines for all new hires and having a mandate with generous medical and religious exemptions for existing staff.

LDH: We want them to understand that we want you protected, we want you to be safe, we want you to be healthy. But we also want to protect everybody else that’s here.

DG: Lesia’s still scared. She still wishes this wasn’t her call.

But more than before, she’s open to the idea that a vaccine mandate might be the right thing to do for her and her business.

When we come back, what a researcher has learned about mandates that could help employers like Lesia who may soon take the plunge.


DG: Welcome back.

Multiple polls taken since President Biden’s announcement show around 6 in 10 Americans support vaccine mandates.

Some companies and employer groups like the Business Roundtable welcomed the news, grateful for the support of mandates they’ve wanted to impose but have been afraid to implement.

Many Republican governors have voiced their opposition, loudly.

News clip: South Carolina Gov. Henry McMaster made national headlines when he tweeted that he will, quoting now, “fight to the gates of hell” against the president’s measures.

DG: Some business owners are worried they’ll end up like a New York hospital where so many people quit rather than get vaccinated that the hospital plans to stop delivering babies for the time being. 

Ashley Ritter has been there. 

Ashley Ritter: After the second vaccination clinic, we’d still only gotten to about 50% of our nursing home staff vaccinated, and a decision had to be made as to what needed to happen next.

DG: Ashley is a geriatric nurse practitioner and heads up clinical care research at NewCourtland, which runs a 180-bed nursing home in Philadelphia.

It was early 2020, and by then, NewCourtland had lost residents and at least one staff member to COVID.

They’d witnessed firsthand what this virus could do, and they had no interest in seeing it continue unchecked.

AR: The leaders at NewCourtland really all came to a point that the only path forward to protect our staff and to protect our residents was for everyone to be vaccinated.

DG: Everyone at the company knew this was a huge decision.

They would be one of the first businesses in the U.S. to institute a COVID vaccine mandate.

But Ashley says the risks of employees quitting paled in comparison to the risks of more people dying.

AR: When there’s something as big as COVID-19 that has taken lives of people that we are close with our residents, we needed to have trust in our staff. And at a certain point, if somebody wasn’t on board with that mission of this organization, it was almost a natural time to part ways because this was the direction that we’re moving going forward.

DG: As a nurse practitioner who has spent her career working in nursing homes, Ashley saw this mandate as a way to avoid returning to the dark, deadly days of 2020.

As a researcher, she saw it as an opportunity to examine a critical and relatively unexplored topic. 

AR: I recommended that we study this closely to determine how effective our approach was and to write that up, to share it with other organizations who potentially would be considering the same type of policy at their institution.

DG: This February, NewCourtland announced that all staff would have to be vaccinated by May 1.

When that day came, 221 of the nursing home’s 246 staff members had their shots — nearly 90%.

Of the remaining 25, seven received exemptions or were on leave.

The other 18 resigned.

AR: It’s hard to lose staff members, no matter what the reason. And it was hard. I think it was very hard to stick to sort of that policy knowing that we would lose some really great people. You please as many people as possible, but the mission is not to please all people right now, it’s to protect the most people with the goal of remaining operational.

DG: It was easier to absorb the hit because by the time people quit, there were fewer residents. 

Overall, it was a tough process, says Ashley, but one that’s paid off.

AR: As cases have increased in the community, we have had very, very few cases. And for the most part, we haven’t had to pause admissions to post-acute care or admissions to long-term care because of COVID-19 cases in our community. We’ve had very few cases among our staff because they were vaccinated, we don’t have people calling out with COVID-19 because they are now catching COVID-19 in the community and bringing that into the building.

DG: Ashley, along with colleagues at NewCourtland and the University of Pennsylvania School of Nursing, documented everything the nursing home did between announcing the mandate in February and it becoming effective in May.

They interviewed nursing home leaders and staff.

And Ashley knows NewCourtland’s experience will be different from other organizations.

But she also knows her case study is one of few published papers on COVID vaccine mandates and could help other employers.

So let’s go through a few of Ashley’s tips. 

DG: Some are common sense things we’ve heard before: make vaccines easy to access, use trusted messengers and talk about it in the office.

Ashley, for example, was constantly sharing resources from Dear Pandemic, an online COVID information campaign she helped found last year. 

Other lessons are a little less intuitive, like not calling it a mandate.

NewCourtland called its policy a “condition of employment.”

AR: Some might say that that’s like just mincing words, it’s the same thing, but a condition of employment is not the same sort of visceral reaction as you’re mandated to do this.

DG: This is also going to take time. 

NewCourtland gave employees nearly 3 months to get on board.

AR: While we want everyone to be vaccinated yesterday, the decision process to become vaccinated is not quick. This is not something that will happen overnight.

DG: And Ashley says employers have to be open to having respectful, non-judgmental conversations with hesitant workers.

AR: We have allowed COVID-19 vaccinations to become polarized and supercharged. So having the space to allow people to come with whatever the concern is that they’re feeling without feeling stupid or silly or just scared allows the real concerns to come to the table and some rich discussion to take place.

DG: Putting a vaccine mandate into place so early was a bold and scary move.

For many employers now, it still feels that way.

Ashley knows every situation is unique with different pros and cons.

But she hopes her experience at NewCourtland offers other businesses some tools and some peace of mind that the reward on the other side is bigger than the risk.

AR: It’s hard to be in a nursing home. When we didn’t have any vaccinations, we had high case rates, being able to talk to another human during a meal, being able to leave your room, you know, being able to give somebody a hug, like that was stuff that really was scary to do.

We’re giving some quality of life back to our nursing home residents, and it’s not perfect protection, but it’s a whole lot better than nothing.

DG: I’m Dan Gorenstein, and this is Tradeoffs.

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Episode Resources

Previous Tradeoffs Coverage of COVID-19 Vaccine Mandates:

Calling the Shots: Should Employers Mandate COVID Vaccines? (5/20/2021)

We Need You (1/14/2021)

Additional Research and Reporting:

Biden meets with business leaders on vaccine mandates (Taylor Telford, Tyler Pager and Eli Rosenberg; Washington Post; 9/15/2021)

6 new developments in Biden administration’s plan to fight COVID-19 (Jeff Levin-Scherz, Willis Towers Watson, 9/14/2021)

Some businesses welcome Biden’s vaccination mandate while others worry about the costs, effects on worker shortages (Paul Davidson, USA Today, 9/12/2021)

White House COVID-19 Action Plan (9/9/2021)

Biden expands vaccine requirements in bid to rein in Covid (Adam Cancryn and David Lim, POLITICO, 9/9/2021)

How one Philly nursing home overcame hesitancy to get 98% of staff vaccinated (Mary Schuler and Ashley Ritter, Philadelphia Inquirer, 8/23/2021)

Implementation of a Coronavirus Disease 2019 Vaccination Condition of Employment in a Community Nursing Home (Ashley Ritter et. al, Journal of the American Medical Directors Association, 8/6/2021)

Episode Credits


Lesia Daniel-Hollingshead, Co-owner, Funtime Clinton

Ashley Ritter, APRN, PhD; Director of Clinical Care Research, NewCourtland; Adjunct Assistant Professor, NewCourtland Center for Transitions in Health, University of Pennsylvania School of Nursing; CEO, Dear Pandemic

The Tradeoffs theme song was composed by Ty Citerman, with additional music this episode by Blue Dot Sessions.

This episode was produced and mixed by Ryan Levi.

Special thanks to:

Jeff Levin-Scherz and Alison Buttenheim

Additional thanks to:

Kevin Volpp, Ellen Magenheim, Navdeep Kaur, the Small Business Majority, Katie Keith, Sabrina Corlette, Syon Bhanot, the Tradeoffs Advisory Board and our stellar staff!