November 2022

This brief is derived from a paper published in Health Affairs entitled “Higher COVID-19 Vaccination and Narrower Disparities in US cities with Paid Sick Leave Compared to Those Without.”

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Summary

Paid sick leave benefits allow workers to take paid time off to care for their health. This includes getting vaccinated for COVID-19 or recovering from common vaccine side effects.

The United States is one of few wealthy nations without a national paid sick leave program, leaving state and local governments to enact their own paid leave policies. However, this leaves about one in five U.S. workers without paid sick leave benefits. These workers, many of whom are frontline workers, tend to have lower incomes, higher exposure to COVID-19, and higher rates of COVID-19 sickness and death.

Our analysis of 37 cities – representing nearly 20% of the U.S. population – found that cities with paid sick leave policies had higher COVID-19 vaccination rates among people of working age and smaller differences in vaccination rates among neighborhoods with varying levels of social vulnerability (a CDC measurement of social and economic factors that can identify neighborhoods at higher risk during an emergency, such as the COVID-19 pandemic).

As COVID-19 and other infectious diseases continue to spread in the U.S., implementing paid sick leave policies in cities and states can support increased vaccination and reduce known barriers to vaccination among working-age people.

Background

Paid sick leave policies give workers paid time off to care for their health or the health of family members. The U.S. is one of few wealthy nations without a national paid leave program, leaving state and local policymakers to determine if and to what degree American workers can afford to take time off to access health care, including getting vaccinated against common infectious diseases like COVID-19 or the flu.

Nearly a quarter of American workers do not have paid sick leave, a gap in coverage that disproportionately affects lower wage workers, higher exposure to COVID-19, and higher barriers to vaccination. This group, which includes many frontline and essential workers, has also experienced the highest rates of illness and death from COVID-19.

Increasing vaccination rates among workers remains crucial, as COVID-19 continues to spread, hospitalizing or killing thousands of Americans each week.¹ Vaccination has been emphasized as a key intervention by federal plans, but vaccination rates have stalled among Americans of working age, and fewer than 10% of those eligible having received the updated boosters in advance of an anticipated winter surge.¹ How can policymakers improve these rates, protecting workers and preventing further disruption?

In a survey of employed U.S. adults, those with paid sick leave were 50% more likely to be vaccinated against COVID-19. Unvaccinated workers reported that having paid time off would increase their likelihood of vaccination, giving them time to both get the vaccine and recover from any side effects without financial penalty.² Building on the knowledge that state paid sick leave policies are associated with lower rates of COVID-19 and flu, we sought to determine if cities with paid sick leave policies had higher COVID-19 vaccination rates and narrower differences in these rates between neighborhoods.

Key Findings

1. COVID-19 Vaccination Rates Were Higher in Cities with Paid Sick Leave

Our analysis covered 37 cities in 25 states and represents more than 66 million people (nearly 20% of the total US population). When we compared COVID-19 vaccination coverage in cities with and without paid sick leave, we found that COVID-19 vaccination rates were higher in cities with paid sick leave policies.

Figure 1 shows the percentage of the study population vaccinated by month in cities with paid sick leave policies versus cities without policies. The blue lines represent those aged 18-64 – residents more likely to be eligible for paid sick leave. For this age group, vaccination rates were 17% higher among residents of cities with paid sick leave policies compared to residents of cities without paid sick leave policies. The orange lines represent residents 65 and older – people less likely to work and be eligible for paid sick leave. For this age group, vaccination rates were similar in cities with and without paid sick leave. The lack of a difference for people 65 and older, who are unlikely to use paid sick leave, supports the finding that the 17% difference in vaccination rates is due to paid sick leave.

2. Cities With Paid Sick Leave Had Narrower Disparities In Vaccination Rates Among Neighborhoods

Additionally, our team found that cities with paid sick leave policies had less variation in vaccination rates by neighborhood. While less socially vulnerable neighborhoods generally had higher vaccination rates, the largest benefits of paid sick leave policies were in the neighborhoods with the highest social vulnerability.

Policy Implications

State paid sick leave policies are associated with lower rates of COVID-19 and influenza-like-illness, and our new research shows that city and state paid sick leave policies can also increase COVID-19 vaccination rates. As protections such as masking requirements are increasingly relaxed, vaccination has become one of few remaining defenses against COVID-19 severity and death. Increasing vaccination coverage will be crucial to protecting frontline workers and their families.

• Cities that do not currently have paid leave policies in place should consider implementing these policies to increase vaccination coverage among all residents and close gaps in vaccination coverage affecting residents of more socially vulnerable neighborhoods.
• Cities that currently have paid sick leave policies can further support vaccination rates by exploring ways to remove remaining barriers to accessing paid sick leave benefits, particularly among low-wage workers, part-time workers, and foreign-born workers, and ensuring that eligible workers are adequately aware of this benefit.
• A number of states have prevented cities from enacting paid sick leave policies, arguing that state laws preempt local ordinances. This creates an environment in which the needs of urban residents cannot be met. Cities facing preemption should advocate for changes to state laws preempting paid sick leave or for statewide paid sick leave policies.
• In the absence of federal paid sick leave policies, state policymakers should consider these findings when evaluating how to increase vaccination rates among residents and strengthen the ability of workers to protect themselves and their families.

Enacting policies that support vaccination can help to prevent illness, hospitalization, and death from COVID-19 and other infectious diseases. Paid sick leave policies address a well-established barrier to vaccination and help to close a gap in federal policy, making it easier for all workers to access the tools to protect their health.

References

¹Centers for Disease Control and Prevention. 2022. COVID Data Tracker. Accessed November 2, 2022.

²Henry J. Kaiser Family Foundation. 2021. Workers are more likely to get a COVID-19 vaccine when their employers encourage it and provide paid sick leave, though most workers don’t want their employers to require it.