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The COVID-19 US Vaccine Sentiment Series

The emergence of the Omicron variant has elevated the importance of vaccination and vaccine mandates in the fight against COVID-19. While uncertainties and legal challenges remain, by early 2022 most companies in the US with more than 100 employees will likely be operating under a vaccination or testing mandate to contain the spread of COVID-19. Even with the emergence of a new “variant of concern,” mandates remain a divisive issue but not an unsolvable one.

Despite the controversy surrounding them, vaccination mandates have generally been working at the more than 200 large companies and organizations that have already implemented them. And BCG survey results suggest that a sizable share of unvaccinated employees remain open to receiving the shots. Yet it’s early, and some of the largest challenges lie ahead. The full impact of widespread mandates outside of health care is not yet known. Health care, an industry accustomed to vaccine mandates, is overrepresented among employers with mandates so far. Early data suggests that companies with large numbers of operational and blue-collar workers may face more resistance.

Already tested by the challenges that COVID-19 has created in its wake, companies now face a two more: the Omicron variant and mandates. The uncertainty and the stakes for leaders just jumped. Leaders will play critical roles in encouraging vaccination, overcoming employees’ resistance to vaccination, and accommodating exempt employees. Political differences aside, the goal is to keep employees, families, and communities safe. Companies can do their part by treating this next challenge as a multifaceted exercise in change management, behavioral science, and adaptability.

Resistance Remains

BCG has been surveying Americans for nearly a year to understand levels of vaccine hesitance. From September 8 to October 1, 2021, we conducted a fifth US COVID-19 Vaccine Sentiment Survey to understand how perceptions of the vaccine and reluctance to be vaccinated have shifted. The findings are especially relevant as workplace mandates are about to come into force. Assuming that courts do not permanently block implementation, companies must prepare for January 4, 2022, when employees must have received their final dose under the administration’s three primary mandate policies.

The Biden administration’s overarching goal is to increase vaccination rates. The three policies are powerful, complex, and interlocked tools: Biden’s executive order covers federal contractors; another (under OSHA’s emergency temporary standard) applies to all organizations with at least 100 employees. And a third (imposed by the US Department of Health’s Centers for Medicare and Medicaid Services) covers staff at organizations receiving Medicaid or Medicare funds.

These policies leave companies with many pressing questions, including:

  • Who needs to be covered under the mandates?
  • How will companies respond to employees’ requests to be exempt from vaccination?
  • How will companies manage exempt employees and keep their other employees safe?
  • How many employees will refuse to comply, and how will employers respond when they do?

The simplest way to satisfy these regulations is to vaccinate as many employees as possible. “Simple,” however, is not the same as “easy.” Among the unvaccinated—those without a single shot—50% said that they would not get vaccinated, while 19% said they were unlikely to change their mind, according to the survey. That leaves 31% who are persuadable. The share is likely higher given the experience of companies that have already put mandates in place.

Fear of side effects is the number one reason the unvaccinated cite for refusing to receive a vaccine, followed by insufficiency of evidence that vaccines work and rushed clinical trials and approvals.

The mandates will impose an operational and reporting burden on companies with large numbers of exempt employees subject to regular testing. Reducing that number as much as possible will allow companies to get back to the business of business.

Mandates Can Work

The large number of organizations that have already introduced mandates is encouraging—but mandates do not necessarily bring about employee compliance. Most unvaccinated employees have already had ample time and opportunity to be inoculated. And more than one-third—or 37%—of the unvaccinated said they would quit their jobs rather than be forced to get the shots. On the other hand, what people say and what they do are often different. Early data suggests that only one in seven of those who say they will leave work—fewer than 15%—actually do so.

The Biden administration’s requirements provide enough flexibility in the form of exemptions or regular testing that the percentage of employees who lose their jobs could be even lower. In a hypothetical company of 100 employees, with 20 of them unvaccinated, seven or eight would threaten to quit and one would follow through. Among the remainder, half would be likely to be vaccinated and the other half would seek an exemption.

In other words, mandates can work. United Airlines and Tyson, two high-exposure companies with mandates, have vaccination rates exceeding 95%. A late August 2021 study from National Safety Council survey found that companies with mandates had vaccination rates close to 94%, compared with 69% at those that did not. Public-sector entities, including state governments and police forces, have experienced similar uptakes, often in the days before the mandates become effective.

Change Management Works, Too

If companies treat mandates only as a compliance issue, they are missing an opportunity to shape the narrative and ultimate success of their programs. Coming out of the COVID crisis, companies have a chance to demonstrate concern and compassion for their employees and to show respect for diverse points of view.

A company’s policies should be grounded in its purpose, culture, and values and brought to life through direct employee outreach and campaigns. Given the tight deadlines—January 4 will be here soon—policies should be simple to understand and give employees sufficient time to prepare.

Execution and scenario planning will be as important as the letter of the policy. The process to address requests for exemptions from vaccination or testing should be clear, fair, and fact based. The tools of behavioral science—especially nudges, the use of trusted ambassadors, and emotional appeals—can be effective in efforts to keep the workplace safe.

Text-Based Nudges. Nudges will work better than sledgehammers in eliciting compliance. A recent study by the University of California at Los Angeles and Carnegie Mellon University, for example, showed that text messages that focus on access and ownership—“The vaccine has been made available for you” or “Claim your dose today”—boosted the number of people, even the hesitant, who received shots. To encourage uptake, the state of Oklahoma began sending educational text messages to residents in areas with the lowest vaccination rates.

Trusted Ambassadors. Trusted or known individuals will likely have more success reaching populations with high hesitancy than unfamiliar HR and legal executives. Tyson Foods, a major meat processor and food conglomerate hit hard in the early days of the pandemic, brought in doctors who served specific ethnic communities to talk with employees. United Airlines executives have personally offered to take hesitant employees to their vaccine appointments.

Emotional Appeals. Emotional appeals are more effective than facts and figures in swaying reluctant employees. Studies suggest that vaccine-hesitant individuals are as much as 2.5 times more engaged on social media and in virtual communities on vaccine-related topics than their pro-vaccine peers. This content is more saturated in personal narrative and emotional connection than pro-vaccine online content.

Vaccine mandates will undoubtedly be modified as new drugs and vaccine boosters come on line, as the virus continues to mutate, as the legal questions are settled, and as society adjusts to COVID-19’s continued presence. Adaptability and nimbleness are the best antidotes to a world that will remain in flux for the foreseeable future.

About the Research

BCG’s COVID-19 Vaccine Sentiment Snapshot series is based on data drawn from an online survey of consumers that is conducted every few weeks across a representative sample of the United States. The survey is produced by the authors in partnership with coding and sampling provider Dynata, the world’s largest first-party data and insights platform. The goal of the research is to provide our clients and businesses around the world with periodic barometer readings of COVID-19-related vaccine sentiment to inform rebound planning, vaccine rollout operations, and decision making. A team composed of BCG consultants and experts from BCG’s Center for Customer Insight completes the survey analytics.

Legal Context

The situation surrounding COVID-19 is dynamic and rapidly evolving, on a daily basis. This COVID-19 research is not intended to: (i) constitute medical or safety advice, nor be a substitute for the same; nor (ii) be seen as a formal endorsement or recommendation of a particular response. As such you are advised to make your own assessment as to the appropriate course of action to take.


We would like to thank key contributors for this article:

  • BCG Global COVID Response Team: John Rose, Tristan Hunt, Laura Mast, and Ian Faucher
  • BCG Center for Customer Insight: Greg McRoskey and the rest of the global team

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Explore Past Snapshots

Snapshot #1: What’s Driving Hesitancy
Two months along in vaccination distribution in the US, BCG’s first survey of vaccine sentiment reveals the groups in which hesitancy is highest and what’s behind the unease.

Snapshot #2: The Hurdles Ahead
The results of BCG’s second survey shed light on what's preventing or discouraging eligible individuals from getting their shots.

Snapshot #3: A Looming Slowdown in Demand
Even as eligibility expands and access improves, hesitancy has not changed dramatically. Meeting the White House’s vaccination goals will require a coordinated public health campaign.

Snapshot #4: Three Paths to 70%
To increase vaccination rates, state and local governments can spread positive messages, improve access, and offer various kinds of incentives.