Asking someone if they’ve had a Covid shot can be tricky. Here’s how to navigate the new norms of health disclosure.
Ashley Z. Ritter’s vaccination conflict came to a head in April. She’d hired a part-time babysitter for her three kids just as the family moved to a new home in Yardley, Pa., last August. The babysitter, Lauren Greenewald, helped manage virtual school for the two older children, 6 and 7, while also juggling the 2-year-old and working toward a master’s degree in school counseling.
Dr. Ritter, a nurse practitioner and postdoctoral fellow at the University of Pennsylvania, strongly preferred that her caregiver be vaccinated against Covid-19 and, once the shot was available, asked Ms. Greenewald about her plans for getting it. Her babysitter was reluctant.
“My main concerns were that it’s under an emergency use authorization,” Ms. Greenewald said, and that the available vaccines don’t yet have full approval from the Food and Drug Administration. “Being a young, healthy person, I’m not really in a high-risk category. I don’t think it’s necessary for me to get it without seeing long-term studies.”
Dr. Ritter had been doling out advice about conflicts just like this one in her role as chief clinical officer for the Dear Pandemic blog. But she discovered it’s another thing altogether to face such a conflict herself.
“She was a blessing to us in a really hard time, and took really great care of our children,” Dr. Ritter said. “This was a hard thing to take.”
These are confusing times, as widening access to the vaccination bumps up against significant pockets of vaccine hesitancy (20 percent of American adults say they definitely won’t get the shot, or only will if it’s “required for work or other activities”). How do you know whether the co-worker sharing your office space has been vaccinated? The same could be asked about college students, professors, pastors and congregants, camp counselors and the web of other relationships we are resuming in person.
When is someone’s vaccination status your business — and what do you do if you don’t like the answer you get? Here’s how a bioethicist, epidemiologist, lawyer and etiquette expert are navigating the new norms of vaccination disclosure.
Whom can you ask?
Whether or not someone has been vaccinated might feel like private medical information, but it can also directly affect your health and that of your family. Most experts agree that, broadly, “it’s fine to ask anyone if they’ve been vaccinated, if it’s going to influence your decisions about what you do or don’t do with them,” said Joseph G. Allen, an associate professor of exposure assessment science at Harvard’s T.H. Chan School of Public Health.
Vaccination status is a key factor in deciding whether to meet with someone indoors or outside, masked or unmasked, or even if you want to re-evaluate the relationship. These choices will often come down to personal risk tolerance — maybe you’d prefer to get your hair cut only by a vaccinated stylist, or maybe you don’t mind if your child’s soccer coach isn’t vaccinated if they’re practicing outdoors.
But remember that nobody owes you an answer, said Nancy S. Jecker, a professor of bioethics and humanities at the University of Washington School of Medicine. “You can always ask,” she said, but the other person could have reasons to keep his or her decision private. “It might have to do with something like pregnancy status, or an underlying chronic condition, or someone’s immigration status.”
This right extends to more structured settings, such as schools. Parents can ask their child’s teacher directly about vaccination, but most state medical privacy laws prevent schools from sharing that information, said Dorit Reiss, an expert on vaccine policy and a professor at the University of California Hastings College of the Law. (Schools might share general data about staff vaccination rates, depending on state and local policy.)
Nor can parents legally ensure that their kids be placed only with immunized adults — but it doesn’t hurt to ask. A day care might accommodate you to keep you as a client, but it doesn’t have to, Dr. Reiss said.
Things get a little easier in the case of camps or sports programs, as concerned parents can shop around for an organization willing to share vaccination rates. Cory Harrison, the director of Y.M.C.A. Camp Greenville, in South Carolina, said he notified parents this spring that 100 percent of its staff was vaccinated. He said the camp encouraged it by allowing only fully vaccinated staffers to leave campus during their off hours.
How do you bring it up?
Lead with the fact that you’re fully vaccinated or will be soon, advised Ruth R. Faden, founder of the Berman Institute of Bioethics at Johns Hopkins University and part of its Covid-19 Vaccine Ethics Research team.
“Sharing is a way to invite sharing,” she said. In a less personal relationship (say, with a stylist or physical therapist), saying, “Great news, I’m now fully vaccinated!” might get you an easy “So am I!” If not, Dr. Faden suggested framing your follow-up like this: “If you think it’s appropriate, can you tell me if you’ve been fully vaccinated? If you don’t want to share that piece of information with me, I understand.”
Closer working relationships, like with a longtime babysitter or house cleaner, are trickier. Katie Provinziano, managing director at West Side Nannies, which has offices in several major cities, has lately been coaching two or three concerned clients every week through this conversation.
She suggested deciding on your bottom line before broaching the subject: Will the job you’re providing require vaccination going forward, or are you willing to bend? Set up a time to talk specifically about vaccination, then share why it’s important to you and be clear about expectations.
“You can create a timeline: ‘Would you be comfortable getting it in the next three months?’” she advised. But if nannies still don’t want to get vaccinated Ms. Provinziano said most families she has spoken to end up letting them go. She added that 98 percent of her company’s positions are open only to those already vaccinated, or planning to be.
“Nannies who decide not to get vaccinated are going to have a much harder time finding work,” she said.
Mandating vaccination is within your rights as a household employer, said Bob King, an employment attorney at the Legally Nanny law firm in Los Angeles. “Employees of larger companies can opt out of getting a vaccine if they have a valid medical reason for it, or a sincerely held religious belief,” he said. But those are federal laws that apply to larger employers, not households.
More confusing: Several states (like Montana) have enacted or proposed laws that prohibit employers from mandating the vaccine, but it’s legally murky whether they’d cover a nanny or other worker in your home, Dr. Reiss said. When in doubt, check your state’s latest legislation.
Keep power dynamics in mind, added Dr. Faden. “Someone may desperately need the job you’ve given them,” she said. When it comes to requiring vaccination, “you are justified in taking that position, but you should be sensitive in that case and give people time.”
Can I try to convince the hesitant?
Yes, if you forget about arguing and instead seek to understand. “Most likely you’re not going to convince them, but you can engage in the conversation,” said Akilah Siti Easter, an etiquette expert and biologist in Chicago. “You’re not judging the person because they decided not to get vaccinated,” you’re trying to understand why they decided not to.
If someone’s reasons stem from misinformation (say, she mistakenly believes the vaccine is linked to infertility), Ms. Easter said it’s worth trying to have a measured conversation. Start by establishing common ground.
“You can say, ‘I was really concerned, too, but I talked to my doctor and asked these questions. Here’s what she told me,’” she said.
But what if you still can’t reach an agreement?
Then it’s time to decide whether coronavirus transmission risks can be mitigated enough to your liking — perhaps your child’s best friend with unvaccinated parents can play with your kid outdoors, with masks on — or if you feel more comfortable cutting ties. This isn’t new; throughout the pandemic, “we’ve had to respect each other’s risk budgets,” Dr. Faden said. Vaccination status is just the latest variable.
Dr. Ritter felt well prepared for this scenario, given her job advising others. “I was trying to practice what we preached: having an open and honest conversation, debunking myths,” Dr. Ritter said. She gave her babysitter scientific information about the vaccine and a few days to think.
When Ms. Greenewald returned to work the next Monday, though, she told her boss she wasn’t ready for the shot. They decided to part ways. “It was very mutually respectful,” Ms. Greenewald said.
Elisabeth Kwak-Hefferan is a freelance writer and editor based in Missoula, Mont.
June 22, 2021 at 11:27PM
https://www.nytimes.com/2021/06/22/well/family/employee-vaccine-status-questions.html
How to Have the Hard Vaccination Conversations - The New York Times
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