POST 145. March 25, 2021. CORONAVIRUS. “Efforts to disseminate Covid-19 vaccines as widely as possible are hitting an unexpected obstacle: health-care workers who decline the shots.

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“Officials from Ohio said recently that 60% of nursing-home staff so far haven’t elected to take the vaccine. In New York, Gov. Andrew Cuomo said this month that state officials expect 30% of health-care workers offered the vaccine will ultimately turn it down. Two-thirds of the staff at a Florida hospital refused the vaccine this month, leaving so many unused doses that the facility started giving away shots to the general public.

The hesitancy among health-care workers concerns public-health officials who expected America’s front-line workers to serve as a model for others.

“Please get vaccinated,” Anthony Fauci, who is serving as President Biden’s chief medical adviser for the Covid-19 pandemic, said in a video message to health-care providers. “It’s important to protect yourselves, to protect your family, but as important, symbolically, as health-care providers, to show confidence in the vaccine so that other people in this country follow suit.”

In a survey of 1,563 respondents conducted in January by researchers at the Kaiser Family Foundation, 79% of U.S. adults who haven’t yet been vaccinated say they would be likely to turn to a doctor, nurse or other health-care provider when deciding whether to get a vaccination.” (A)

“Dr. Jeremy Boal, chief clinical officer of the Mount Sinai Health System, said that among high-priority staff members offered the vaccine, acceptance ranges from 25% at one of the network’s eight campuses to 65% at another. (He declined to name the specific facilities.)

“In critical care units, emergency departments, and those kinds of places, the uptake rates tend to be very high,” Boal told Gothamist. “We’re not seeing the same degree of uptake in many of our support departments, such as engineering services and environmental services.”

He said deferral does not mean refusal.

“A lot of them are taking their time to make the decision,” Boal said.” (B)

“Despite confronting the damage of covid-19 firsthand—and doing work that puts them and their families at high risk—health-care workers express similar levels of vaccine hesitancy as people in the general population. Recent surveys suggest that, over all, around a third of health-care workers are reluctant to get vaccinated against covid-19. (Around one in five Americans say they probably or definitely won’t get vaccinated; nationwide, hesitancy is more common among Republicans, rural residents, and people of color.) The rates are higher in certain regions, professions, and racial groups. Black health-care workers, for instance, are more likely to have tested positive for the virus, but less likely to want a vaccine. (Thirty-five per cent turned down a first dose.) Compared with doctors and nurses, other health professionals—E.M.T.s, home health aides, therapists—are generally less likely to say that they’ll get immunized, and a recent survey of C.N.A.s found that nearly three-quarters were hesitant to get the vaccine….

This hesitancy is less outright rejection than cautious skepticism. It’s driven by suspicions about the evidence supporting the new vaccines and about the motives of those endorsing them. The astonishing speed of vaccine development has made science a victim of its own success: after being told that it takes years, if not decades, to develop vaccines, many health-care workers are reluctant to accept one that sprinted from conception to injection in less than eleven months. They simply want to wait—to see longer-term safety data, or at least to find out how their colleagues fare after inoculation.

Another major hurdle is mistrust of both the political and the health-care systems. The problem is most acute in historically marginalized communities, which already live with racial disparities in life expectancy, maternal mortality, access to medical care, representation in clinical trials, informed consent, the physician workforce, and covid-19 outcomes. And it’s exacerbated among health-care workers who are underappreciated and poorly paid. “In many cases, vaccine hesitancy is not a lack-of-information problem. It’s a lack-of-trust problem,” David Grabowski, a professor of health-care policy at Harvard, told me. “Staff doesn’t trust leadership. They have a real skepticism of government. They haven’t gotten hazard pay. They haven’t gotten P.P.E. They haven’t gotten respect. Should we be surprised that they’re skeptical of something that feels like it’s being forced on them?”..(C)

“Many Americans cannot wait to get the COVID-19 vaccine. They call hotline numbers. They search online for vaccine clinics. They wait for hours in line. Yet, others with ready access to the vaccine have declined it in large numbers. Staff in long-term care facilities were prioritized to receive the vaccine, but many are choosing not to get vaccinated. Why?

Nobody is more familiar with the impact of COVID-19 than staff at nursing homes and assisted living facilities that have been ground zero for the pandemic. Large numbers of residents and staff have contracted the virus. Nearly 40% of the COVID deaths in the US have occurred among residents of these facilities. Over 1,500 nursing home staff have also died from COVID, making nursing home caregiver the most dangerous job in America.

Nonetheless, many long-term care staff continue to refuse the COVID-19 vaccine. In a recent CDC report, nursing homes had a median vaccination rate of 37.5% for staff during the first month of the federal vaccination effort; by comparison, a median of 77.8% of nursing home residents received the vaccine. This has surprised some policymakers. Recently, Maryland’s acting health secretary told state lawmakers that about one-third to one-half of staff offered the vaccine chose to have it –– nowhere near an expectation of 80% to 90%. In a bit of positive news earlier this month, a large national nursing home chain reported 61% of staff and 84% of residents had been vaccinated as of early February, still far short of many policymakers’ expectations…

We have historically undervalued the work of caregivers in long-term care facilities. They perform a difficult job for pay at or near minimum wage, with few benefits like health insurance or paid sick leave. They often work at multiple facilities in order to earn a living wage. Many facilities are understaffed with high turnover. The vast majority of caregivers are women, and many are people of color and recent immigrants. They may be treated poorly while being asked to work long hours at low pay.

Since the start of the pandemic, this workforce has been further exploited. They have often had to work in facilities that were severely short-staffed, without adequate personal protective equipment or rapid COVID testing. Many staff did not receive hazard or hero pay despite working in the most dangerous of conditions. Not surprisingly, many staff do not trust management at the facilities where they work.” (D)

“Dr. Nikhila Juvvadi, the chief clinical officer at Chicago’s Loretto Hospital, administered the first coronavirus vaccine doses in the city, inoculating frontline medical workers.

But while they have priority around the country, not every eligible health care worker actually wants to get the vaccine. A recent survey by Kaiser Family Foundation found that nearly a third probably or definitely would refuse vaccination.

Juvvadi says that, in her hospital, a lot of that hesitancy is based on minority groups’ deep-rooted mistrust of vaccinations and other large-scale health care programs: “I’ve heard Tuskegee more times than I can count in the past month — and, you know, it’s a valid, valid concern.”” (E)

“Experts believe vaccine hesitancy among health-care workers may become a significant obstacle in the federal government’s quest to immunize the public. But why are they hesitant?

The reasons are complex, and only some are specific to COVID itself. The anti-vaxx movement seeds social media with conspiracy theories and hoax cures, and once the pandemic hit, disinformation proliferated. But health-care workers like Negron and Phillip also spent the last year on the frontlines of a relentless and confusing crisis. When the virus first appeared in the U.S., the Trump administration stumbled, issuing contradictory safety recommendations to health-care workers. They often lacked protective gear. Some even blew the whistle on their own employers, risking their livelihoods to reveal deadly safety lapses in nursing homes and hospitals across the country. Now the same employers are asking workers to get a new vaccine.” (F)

“The extent to which healthcare workers are refusing the vaccine is unclear, but reports of lower-than-expected participation rates are emerging around the country, raising concerns for epidemiologists who say the public health implications could be disastrous.

A recent survey by the Kaiser Family Foundation found that 29% of healthcare workers were “vaccine hesitant,” a figure slightly higher than the percentage of the general population, 27%.

“Even the name, Operation Warp Speed, draws some concern for people about the rush to push it through,” said Dr. Medell Briggs-Malonson, an emergency medicine physician at UCLA Health who has received the vaccine. Still, she urged her colleagues to do the same.

“It’s certainly disappointing,” said Sal Rosselli, the president of the National Union of Healthcare Workers. “But it’s not shocking, given what the federal administration has done over the past 10 months. … Trust science. It’s about science, and reality, and what’s right.”

The consequences are potentially dire: If too few people are vaccinated, the pandemic will stretch on indefinitely, leading to future surges, excessive strain on the healthcare system and ongoing economic fallout.

“Our ability as a society to get back to a higher level of functioning depends on having as many people protected as possible,” said Harvard epidemiologist Marc Lipsitch.” (G)

“In New York State, African-Americans make up about 17 percent of the adult population but have received only 10 percent of the shots. That is because of difficulties gaining access to the shots but also because of a lingering reluctance — and that has rung true at Harlem Hospital, where a majority of the staff is Black, administrators said.

The situation at Harlem Hospital underscores how entrenched this mistrust can be: Even workers at a hospital where the vaccine is readily available are wary of getting inoculated. But it also shows how it is possible to make progress in changing attitudes about the vaccines, even if slowly.

At Harlem Hospital and nationally, confidence in the vaccines has been rising among Black Americans. Recent polls show that Black Americans, though initially more skeptical, are now about as likely to want to get vaccinated as white Americans, and that politics, not race, is emerging as a larger divide. Republicans are now the group with the highest degree of skepticism: In a late February CBS News poll, 34 percent of Republicans said they would not be vaccinated against Covid-19, compared with 10 percent of Democrats….

Harlem Hospital’s low vaccination rate did not come as a surprise to its leaders. A poll taken at the institution in late 2020 before the vaccines were approved, showed that only 30 percent of workers there were willing to be vaccinated, said Eboné Carrington, the hospital’s chief executive officer.

Black workers cited concern rooted in the legacy of medical injustices like the Tuskegee experiment, a study by the U.S. government that withheld syphilis treatment from Black men, and general skepticism of a vaccine developed quickly, under a presidential administration they did not trust.

“The staff reflects a population of people who traditionally are reluctant to vaccinate, and not just hesitant, but rightfully fearful, at having been wronged,” she said.” (H)

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