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More Hospitals Are Requiring Workers to Get Covid Vaccines

With increasing caseloads driven by the Delta variant and persistently low vaccination rates in their communities and even within their own workforce, more and more hospitals and major health systems are requiring employees to receive the Covid-19 vaccine.

Numerous hospitals claim that their efforts to immunise their employees have come to a grinding halt, a situation similar to that of the nation’s overall vaccination rates, which remain below 60 percent, lagging behind many European countries and Canada. However, despite the fact that thousands of health-care workers have died as a result of the virus and countless more have been sickened, according to the American Medical Association, health-care workers in general, and those working in rural areas in particular, have proven to be more resistant to the virus.

Recent estimates indicated that one in every four hospital employees had not received the required vaccinations by May 31, with some facilities reporting that fewer than half of their employees had received the required shots.

In some cases, such as those at NewYork-Presbyterian and Yale New Haven hospitals, and larger health-care organisations such as Trinity Health, mandated vaccinations are being implemented because they recognise that the only way to stop an outbreak of the virus is to vaccinate the most people, the fastest possible. As of Tuesday, a large Arizona-based chain, Banner Health, had announced that it would implement an immunisation mandate, and New York City had announced that it would require all health care workers at city-run hospitals or clinics to be vaccinated or to submit to weekly testing.

As a result of the increasing number of cases, Trinity Health, a Catholic system with hospitals in 22 states, became one of the first major organisations to decide earlier this month that it would mandate immunizations for employees. “We were convinced that the vaccine had the potential to save lives,” said Dr. Daniel Roth, chief clinical officer at Trinity. “These are deaths that could have been avoided.”

According to Chad Neilsen, director of infection prevention at UF Health Jacksonville in Florida, the number of Covid patients being treated has increased to levels not seen since January, and only half of the hospital’s health-care workers have been vaccinated, according to the CDC. One hundred and seventy-five employees are absent due to illness caused by the virus, the vast majority of whom are unvaccinated, and more are awaiting the results of tests. “We are having a tremendous amount of difficulty with staffing right now,” he said.

“It feels like déjà vu,” Mr. Neilsen said, describing his growing frustration with colleagues who were refusing to take the pictures. “We have reason to believe that if people get vaccinated, this could be the end of it.”

Although there have been dozens of virtual town halls, question and answer sessions, and educational videos, many employees are wary of the new technology. “We were still in a rut,” Mr. Neilsen admitted.

Some employees want more information, while others believe that the process has been rushed to a conclusion. Many of the same conspiracy theories and misinformation, such as the notion that vaccines will cause women to become infertile or that they contain microchips, are held in high regard among the staff. As he put it, “our health-care workers are an accurate reflection of the general population.”

He said hospital administrators and other stakeholders plan to meet with state officials in the coming weeks to discuss the possibility of imposing a mandate.

Unvaccinated workers also continue to provide care to even the sickest patients, raising concerns that they will spread the infection, especially now that the highly contagious Delta variant accounts for more than 80 percent of all cases in the country, according to the CDC.

In hospitals, where health care personnel — who have been heroic during this pandemic — are caring for patients with a wide variety of health challenges under the assumption that the health care professionals treating them are not at risk of acquiring or transmitting Covid-19, Dr. David J. Skorton, the chief executive of the Association of American Medical Colleges, said in a written statement.

Earlier this week, two more organisations, including the American Hospital Association, added their voices to the growing chorus calling for vaccine mandates. America’s Essential Hospitals, which represents hospitals in underserved communities, has lost too many caregivers as a result of Covid-19, according to Dr. Bruce Siegel, the organization’s chief executive. “Vaccination has the potential to reduce the likelihood of us losing more.”

Even though FDA formal approval of the vaccines is expected to take months, hospitals find themselves at the centre of a national debate over whether to impose mandates on vaccinations. Supporters of the vaccines argue that there is ample evidence that the vaccines currently available in the United States are both safe and effective, despite the fact that the vaccines are being offered under an emergency use authorization.

States such as Missouri, which has seen a significant increase in the number of reported cases, are experiencing a new sense of urgency. We felt we couldn’t afford to wait any longer, according to Dr. Shephali Wulff, the director of infectious diseases for SSM Health, a Catholic hospital system with its headquarters in Saint Louis. SSM, where approximately two-thirds of employees have now been vaccinated, has mandated that everyone receive their first dose by September 1.

SSM’s decision was also prompted by concerns that the number of Covid infections could increase this fall, at a time when the number of other respiratory infections could increase as well. In preparation for flu season, Dr. Wulff stressed the importance of having a healthy workforce. “We don’t have the luxury of waiting for approval,” says the team.

Many employees quit their jobs because of the stress and burnout they experienced while caring for Covid patients, and some systems are already concerned about staffing shortages as a result of the pandemic’s departures during the outbreak. Hospitals are hesitant to take the risk of losing more employees if they are forced to do so.

According to Ann Marie Pettis, president of the Association for Professionals in Infection Control and Epidemiology, one of the professional organisations that is urging hospitals to require the vaccine, “they are afraid it could be a tipping point.”

Executives at Mosaic Life Care, a small Missouri hospital group, are hesitant to impose a mandate if other hospitals do not follow suit. A spokeswoman for Mosaic, which has had approximately 62 percent of its employees immunised, stated that “we have the potential to lose some caregivers to other systems.”

In fact, many hospitals have already mandated that their employees get flu shots, a requirement that has been in place for more than a decade. While this was met with some resistance from employees who were sceptical of the vaccines’ safety at the time, it is now widely accepted by the public. Individuals can request a medical or religious exemption, which typically represents a small sliver of the work force. According to hospitals, this exemption would also apply to the Covid vaccines.

Mandatory vaccinations “establish a social norm and declare it to be an institutional priority,” according to Saad B. Omer, director of the Yale Institute for Global Health, who stressed that hospitals must strongly encourage employees to voluntarily receive the vaccines in order for the programme to be successful.

Unions such as the National Nurses United and the 1199 S.E.I.U. say they support vaccination for their members, but they oppose making it a condition of their employment. A group of employees at Houston Methodist, the first hospital to impose a mandate, filed a lawsuit to challenge the requirement, which was recently dismissed. Out of a total work force of approximately 26,000 people, approximately 150 employees resigned or were fired as a result of their refusal to comply with the vaccination deadline.

Hospitals say they are putting forth significant effort to dispel much of the widespread misinformation about vaccines that exists, including among physicians and nurses.

According to Dr. Wulff, “I have to remind them that reputable scientists do not publish their findings on YouTube.” Besides sharing hard data about the vaccine with the public, she and her colleagues at SSM are also sharing their personal experiences with the vaccine, such as getting the vaccine while trying to conceive. “What I’m finding is that stories and anecdotes have the ability to move people,” she said.

As Dr. Wulff explained, “in general, it involves a great deal of listening and zeroing in on the source of their anxiety.”

Some well-known healthcare systems, such as Intermountain Healthcare and the Cleveland Clinic, are on the lookout. A spokesperson for the clinic, which operates a large network of 18 hospitals across the United States, stated that existing policies, such as masking and closely tracking infections, protect patients and employees.

Cleveland Clinic Chief Caregivers Officer K. Kelly Hancock stated, “We are confident that by ensuring these safety precautions are in place, we can continue to keep our patients and caregivers safe.”

She estimates that approximately three-quarters of employees have now been vaccinated, and that efforts are continuing “in full force.”

Dr. Kristin Dascomb, medical director for infection prevention and control and employee health at Intermountain Healthcare, which is based in Utah, says that “a good majority” of the company’s employees are vaccinated.

If more safety data becomes available and the Food and Drug Administration approves the vaccines, Intermountain Medical Center and other hospitals in the state may impose immunisation requirements. “We are starting the conversation right now in Utah,” she explained further.

The lack of full FDA approval has also had an impact on other hospitals in the area. Following the approval of the vaccines, Mass General Brigham said it would implement the requirement as soon as possible.

According to some hospitals, a mandate is not necessary. Suresh Gunasekaran, the chief executive officer of the University of Iowa Hospitals & Clinics, stated, “In my opinion, there is no single correct answer.” He stated that approximately 90 percent of the company’s employees have now been immunised, and that he was confident that virtually everyone would be immunised by the end of the year.

In part because Iowa was involved in the clinical trials for the Pfizer-BioNTech vaccine, Mr. Gunasekaran believes the system has been “successful in chipping away at vaccine hesitancy.”

Northwell Health, a large New York hospital group, does not require its employees to be immunised against the flu, but according to Maxine Carrington, Northwell’s chief human resources officer, approximately 90 percent of its workforce is protected against the virus. It is adopting a strategy similar to that of Covid.

According to Ms. Carrington, the goal is for people to become believers so that they can more effectively persuade the rest of the community to get vaccinated. She described the system as “pounding the pavement on education, education, education,” adding that it was “pounding the pavement on education, education, education.” Approximately 76 percent of the company’s workforce is currently immunised against Covid. She stated that after the Food and Drug Administration approves the vaccines, Northwell will revisit the idea of a mandate.

Yale New Haven Health, like the other hospitals in Connecticut, is now requiring its employees to be immunised against certain diseases.

“From the very beginning, we messaged that it isn’t mandatory — yet. We emphasized the yet,” said Dr. Thomas Balcezak, the chief clinical officer for Yale.

“Health care has to lead,” he said.


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