More and more hospitals and large health systems are requiring their employees to receive the Covid-19 vaccine, due to rising case numbers due to the Delta variant and persistently low vaccination rates in their communities and even within their workforce.
Many hospitals say their efforts to vaccinate their staff have stalled, just as the country’s overall vaccination rates remain below 60 percent, behind many European countries and Canada. While more than 96 percent of doctors say they are fully vaccinated, health care workers in rural areas in particular have shown to be more resistant, although thousands of workers have died from the virus and countless more contracted, according to the American Medical Association.
A recent estimate suggests that one in four hospital workers had not been vaccinated by the end of May, with some facilities reporting that fewer than half of their staff had received the vaccination.
Some hospitals, from academic medical centers like New York-Presbyterian and Yale New Haven to big chains like Trinity Health, carry out a mandate because they realize that the only way to stop the virus is to have as many people as possible possible to vaccinate as soon as possible. A major Arizona-based chain, Banner Health, announced Tuesday that it would be issuing a mandate, and New York City said that all health care workers in city hospitals or clinics should be vaccinated or tested weekly.
The surge in cases caused Trinity Health, a Catholic system with hospitals in 22 states, to become one of the first large groups to decide earlier this month to require vaccinations. “We believed the vaccine could save lives,” said Dr. Daniel Roth, Trinity’s Chief Clinical Officer. “These are preventable deaths.”
At UF Health Jacksonville, Florida, the number of Covid patients treated has increased to levels not seen since January, and only half of health care workers are vaccinated, said Chad Neilsen, director of infection prevention. 75 employees have contracted the virus, the vast majority of them unvaccinated, while others are waiting for test results. “We are currently having major problems with the staff,” he said.
“It’s like déjà vu,” said Neilsen, describing the growing frustration at colleagues’ refusal to get the recordings. “We have reason to believe that this could be over if people get vaccinated.”
Despite dozens of virtual town halls, question-and-answer sessions, and instructional videos, many employees are suspicious. “We are still stagnant,” said Mr Neilsen.
Some employees want more data, others think the process is too rushed. Much of the same conspiracy theories and misinformation – that the vaccines make women sterile or contain microchips – prevail among the staff. “Our healthcare workers are a reflection of the general population,” he said.
Hospital directors and others plan to meet with state officials in the coming weeks about the option to mandate, he said.
Unvaccinated workers continue to care for even the sickest patients, raising concerns that they are spreading the infection, especially now that the highly contagious Delta variant accounts for more than 80 percent of cases in the country.
“Nowhere is this more important than in hospitals where medical staff – who were heroic during this pandemic – care for patients with a variety of health problems on the assumption that the healthcare professionals treating them are not at risk or transmission of Covid-19”, said Dr. David J. Skorton, executive director of the Association of American Medical Colleges, which represents teaching hospitals, in a statement last Friday calling for a mandate.
On Wednesday, two more groups, including the American Hospital Association, joined the growing call for vaccine mandates. “We lost too many of our caregivers to Covid-19,” said Dr. Bruce Siegel, the executive director of America’s Essential Hospitals, which represents hospitals in underserved communities. “Vaccination can reduce the risk of losing more.”
With the formal approval of the vaccines by the Food and Drug Administration may still be months away, hospitals are at the center of the national mandate debate. While the vaccines are offered under an emergency license, proponents argue that there is ample evidence that the vaccines available in the United States are both safe and effective.
There is a new urgency in states like Missouri, which have reported a surge in cases. “We felt we couldn’t wait,” said Dr. Shephali Wulff, the director of infectious diseases at SSM Health, a Catholic hospital system headquartered in St. Louis. SSM, which now has about two-thirds of its employees vaccinated, requires everyone to have their first dose by September 1st.
SSM’s decision was also motivated by concerns that Covid infections could rise this fall when other respiratory infections could also rise. “We need healthy workers for the flu season,” said Dr. Wulff. “We don’t have time to wait for approval.”
However, some systems already fear staff shortages due to departures during the pandemic, as many employees quit because of stress and burnout in the care of Covid patients. Hospitals are reluctant to lose more staff when forcing the problem.
July 26, 2021, 7:21 p.m. ET
“They fear this could be a turning point,” said Ann Marie Pettis, president of the Association for Professionals in Infection Control and Epidemiology, one of the professional organizations calling on hospitals to request the vaccine.
At Mosaic Life Care, a small hospital group in Missouri, executives are reluctant to take on mandates when other hospitals fail. “We have the potential to lose some caregivers to other systems,” said Joey Austin, a spokeswoman for Mosaic, which has vaccinated about 62 percent of its employees.
Many hospitals already require their staff to have a flu shot, which has been around for over a decade. Although this met with resistance from employees who were skeptical about the safety of the vaccines, it is now widely accepted. Individuals can apply for a medical or religious exemption, which is typically a small portion of the workforce that hospitals say would also apply to the Covid vaccines.
Mandates “impose a social norm and say it is an institutional priority,” said Saad B. Omer, director of the Yale Institute for Global Health, who stressed that hospitals must strongly encourage their workers to receive the vaccines voluntarily, in order to be successful.
Unions like National Nurses United and 1199 SEIU say they want their members to be vaccinated but refuse to make it a condition of employment. At the first mandated hospital, the Houston Methodist, a group of staff sued to challenge the request, but the lawsuit was recently dismissed. Out of a total workforce of around 26,000 people, around 150 left or were made redundant because they could not meet the vaccination deadline.
Hospitals say they are working hard to dispel much of the widespread misinformation surrounding the vaccines, even among doctors and nurses.
Understand the state of vaccine mandates in the United States
“I have to remind them that serious scientists do not post their results on YouTube,” said Dr. Wulff. She and her colleagues at SSM not only present hard data on the vaccine, but also share their personal experiences, such as being vaccinated while trying to get pregnant. “What I’m asking is that stories and anecdotes move people,” she said.
“In general, you listen a lot and focus on what drives your fear,” said Dr. Wulff.
Some high profile systems like Intermountain Healthcare and the Cleveland Clinic are waiting. The clinic, which has an extensive network of 18 hospitals across the United States, said existing policies like masking and tracking infections protect patients and workers.
“We know that we can continue to protect our patients and caregivers by ensuring these safety precautions are in place,” said K. Kelly Hancock, chief caregiver officer, Cleveland Clinic.
About three-quarters of the staff are now vaccinated and efforts are continuing “at full speed,” she said.
At Intermountain Healthcare, based in Utah, “a good majority” of employees have been vaccinated, said Dr. Kristin Dascomb, medical director for infection prevention and control and employee health.
If more safety data is required and the FDA approves the vaccines, Intermountain, along with other hospitals in the state, can request a vaccination. “We’re starting the conversation in Utah now,” she said.
The lack of full FDA approval has affected other hospitals as well. Mass General Brigham, who vaccinated more than 85 percent of his workforce, said he would adopt the requirement once the vaccines are approved.
Some hospitals argue that a mandate is not required. “I don’t think there is one right answer,” said Suresh Gunasekaran, general manager of the University of Iowa Hospitals & Clinics. About 90 percent of workers are now vaccinated, he said, adding he was confident that virtually everyone will be vaccinated by the end of the year.
The system was “successful in eliminating vaccine hesitation,” Gunasekaran said, in part because Iowa was involved in clinical trials for the Pfizer BioNTech vaccine.
Northwell Health, the large New York hospital group, doesn’t require workers to be vaccinated against the flu, but about 90 percent of their workforce is vaccinated, said Maxine Carrington, Northwell’s chief human resources officer. The same applies to Covid.
“We want people to be believers,” said Ms. Carrington, so that they can better convince the entire ward to get vaccinated. She described the system as “beating the pavement on education, education, education”. Around 76 percent of the workforce are currently vaccinated against Covid. Northwell will reconsider the idea of a mandate after the FDA approves the vaccines, she said.
Yale New Haven Health is now requiring employees to be vaccinated, as are the other Connecticut hospitals.
“From the beginning we pointed out that this is not mandatory – not yet. We emphasized that, ”said Dr. Thomas Balcezak, Yale’s chief clinical officer.
“The health system has to lead,” he said.