As the World Anticipates a COVID-19 Vaccine, What Should Employers Be Considering?

As scientists actively pursue the development of a COVID-19 vaccine, employers anticipate many factors that impact their workforce. Approval processes, availability of supply, population prioritization, affordability and coverage are just some of those considerations.

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September 22, 2020

Around the world, scientists are actively pursuing the development of a COVID-19 vaccine. Currently, dozens of COVID-19 vaccine candidates are in various stages of development (Figure 1). With recent news of some vaccine candidates in Phase III trials (the final phase prior to manufacturing and distribution) and certain countries already deploying their own Phase III vaccine for use among its citizens, Business Group on Health has heard from several member companies asking how they should be planning and preparing to support their employees around the world once a vaccine is available. At this point in time, there remain many unknowns, making the ability for strategic preparation somewhat limited. Nonetheless, there are some steps that employers can take.

Figure 1: COVID-19 Vaccine Development Progress1

Here are some considerations for employers with regard to a future COVID-19 vaccine:

Approval

Each country’s appropriate health authority, such as the Food and Drug Administration (FDA) in the U.S., will determine when a vaccine(s) has been approved for the country. This means that both the particular drug(s) that are approved as well as the timeline for the approval, will likely vary by country. 

Availability and Supply

Some members have asked about sourcing supply directly and providing COVID-19 vaccination drives for employees, similar to flu vaccination drives. The supply and procurement related to a new vaccine for COVID-19, however, will be very different, as several experts predict that at least initially, demand for the vaccine will outweigh supply. Some country governments have already begun preordering supply in anticipation of a drug’s approval. It is possible that some countries may be able to source and procure the vaccine before other countries, giving employees in certain countries the opportunity to get vaccinated before employees in other countries. It is expected that in many locations, governments and national health systems will control supply to prioritize certain populations. 

On September 16, 2020, the U.S. released its guidance for COVID-19 vaccination distribution.  The strategy includes “centralized distribution allowing the government full visibility, control, and the ability to shift assets and use data to optimize vaccine uptake.2” With this model, employers will not be sourcing the vaccine directly, as the supply and distribution will be controlled centrally by the government and respective health agencies. Until a vaccine is authorized or approved by the FDA, specifics such as:  confirmation of the populations for whom the vaccine is most appropriate, dosage requirements and distribution particulars remain unknown. 

The U.S. plan outlines a three-phase structure (Figure 2) for distribution. The plan initially prioritizes certain populations in phase 1, when a limited number of doses is available, expanding the population in phase 2 as availability of the vaccine increases. Phase 3 of this plan indicates that should the threat of COVID-19 persist as a public health need requiring ongoing vaccination, then COVID-19 vaccinations would eventually be integrated into routine vaccination programs for universal availability.

Projected Distribution of the COVID-19 Vaccine 
Figure 2: Projected Distribution of the COVID-19 Vaccine2

While we may not know the specific populations who will initially be prioritized until a specific vaccine has been approved, some experts say that governments worldwide are likely to prioritize populations as follows:

  • health care workers;
  • essential workers; and
  • those with underlying medical conditions and those age 65 and older.

After these groups have been prioritized, the remaining populations would be eligible, likely several months after a vaccine first becomes available.

According to a recent report by Littler, the U.S. Centers for Disease Control (CDC) described a draft 4-phase priority list for those who will be eligible to receive the vaccine(Figure 3).

Populations Who Will Receive the Vaccination by Phase 
Figure 3: Populations Who Will Receive the Vaccination by Phase3

Affordability & Coverage

Another question raised by many has been related to the cost of the vaccine and if its coverage by the health system (both the public system and private insured market) will follow that of other vaccines in terms of reimbursement and out- of- pocket costs.

In the U.S., the CARES Act includes language requiring coverage of a vaccine at 100% as a preventive service, provided the vaccine is recommended by the U.S. Preventive Services Task Force or the CDC’s Advisory Committee on Immunization Practices.  The report issued September 16 reinforces this requirement.

For companies outside the US, once answers to the prerequisite questions related to approvals and distribution have become clearer, employers should work with their consultants and brokers to determine if the new COVID-19 vaccine is covered by the public system. In addition, a company’s consultant and broker can help determine if discussions are needed with local carriers on whether coverage for the COVID-19 vaccine is included in their plan designs. 

As with any medical advancement or vaccine development, safety and effectiveness are of paramount importance. Employers can continue to play a role in promoting good health by providing science-based information in their communications and enabling access to all recommended vaccines through plan design.

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TABLE OF CONTENTS

  1. Approval
  2. Availability and Supply
  3. Affordability & Coverage