Protecting Health During COVID-19 and Beyond: A Global Examination of Paid Sick Leave Design in 193 Countries

Background: Staying home when sick is essential to reducing the spread of COVID-19 and other infectious diseases. Well-designed paid sick leave is critical to ensuring workers stay home when sick both when the economy is open and during the economic shutdown. Methods: Legislative guarantees of paid sick leave were assessed across 193 countries to determine the extent to which countries guaranteed adequate paid sick leave to respond to the threats of COVID-19. Legislation was assessed for the availability of leave from the first day of illness, duration of paid leave, whether it ensured adequate wage replacement, how leave was provided, and whether coverage extended to workers in small businesses, self-employed workers, and part-time workers. Findings: While strong models exist at every income level, critical gaps that jeopardize health and economic security remain in paid sick leave policies. 27% of countries do not guarantee paid sick leave from the first day of illness, which is essential to encouraging workers to stay home when they are sick. 36% limit access to paid leave for workers who have recently changed jobs, 58% of countries do not have explicit provisions to ensure self-employed workers have access to paid sick leave benefits, and 66% do not have explicit provisions for part-time workers. Interpretation: Comprehensive paid sick leave policies that cover all workers are urgently needed if we are to reduce the spread of COVID-19, and be ready to respond to threats from new infections in the future as well as to the ongoing threat from recurring infections, such as seasonal influenza. Funding Statement: Funding for the data in this article was provided by the William & Flora Hewlett Foundation. Declaration of Interests: The authors declare no competing interests.