POST 123. February 4, 2021. CORONAVIRUS. “Nursing homes across the country are facing the same struggle, as workers have been more reluctant than residents to be vaccinated…

“Though rates vary widely, the American Health Care Association, which represents for-profit nursing homes, estimates that about 50 percent of long-term care staff members have been hesitant to get vaccinated. The majority of direct-care workers in nursing homes are people of color, who have generally been more hesitant to get vaccinated, based in part on their distrust of the federal government and the United States’ history of medical racism.

In Utah, 57 percent of long-term care workers have accepted the first dose, compared to 86 percent of residents, according to the state health department. As of early January, only 40 percent of nursing home workers in Ohio had elected to get vaccinated, according to figures cited by Gov. Mike DeWine…” (A)

“While residents of nursing homes and their caregivers have been considered a top priority for COVID-19 vaccination, only 38% of nursing home staff accepted shots when they were offered, new data from the Centers for Disease Control and Prevention revealed Monday…

“These findings show we have a lot of work to do to increase confidence and also really understand the barriers to vaccination amongst this population,” said Dr. Radhika Gharpure, lead author of the study and a member of the CDC’s Vaccine Task Force.

The report cited previous polling data to suggest why employees have been declining vaccines.

Many raised concerns about vaccine side effects. Others said they didn’t want to be among the first to receive the vaccines, which were first authorized in December. Some said they didn’t trust the government, or referenced false claims about the shots.

It’s also possible, Gharpure said, that some people didn’t get vaccinated because they weren’t working when the shots were distributed, or because they work in multiple facilities and were only counted at one…

The Trump administration initiated the Pharmacy Partnership with drugstore chains CVS and Walgreens, who agreed to pay three visits to every participating nursing home, vaccinating as many people as possible the first two times, and providing the second required dose on the later visits.

The vaccines are provided for free with the pharmacies billing private insurers and Medicaid and Medicare for administration fees.

More staff members are signing up for shots on the second and third visits, suggesting the hesitancy may be waning at least somewhat, Link-Gelles said…

Walgreens said it is learning from the reticence of nursing home workers.

“While vaccine hesitancy has been a challenge at some of these facilities, our pharmacists have played a critical role in providing education and information to help residents and staff understand the important role these vaccines will play in helping the nation emerge from this pandemic,” Walgreens President John Standley said in a statement.

Lack of information about the vaccines may explain some of the hesitancy, the report concluded.

The Trump administration promised for months that it would launch a public information campaign about the vaccines but it never materialized.

A nursing-home specific “toolkit” became available late last year, at about the same time vaccinations became available. The Centers for Medicare & Medicaid Services and private groups are also launching communication initiatives.

Link-Gelles said she understands that the vaccine is new, and hopes more people will take it as they see it working well in others.

“Hesitancy, we’ve seen has been a problem not just in this group but across the country,” she said. “Other data has shown that as people have become more comfortable with the vaccines and …  obviously not seeing a lot of very serious adverse events, that people will become more comfortable. This population is hopefully no different.”

Health-care worker acceptance appears to increase in facilities that have done more to educate staff members about the safety and effectiveness of the COVID-19 vaccines.” (B)

“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)

“Elaine Ryan, AARP’s vice president for state advocacy and strategy integration, says low participation stems from subpar working conditions that nursing home staff have endured for years. “These workers are poorly paid, get few benefits or sick leave and receive very little information and support when they need it,” she says. “Can you blame them for not rushing to get a shot they know very little about, from [the nursing homes] who have treated them so badly?”…

Many long-term care workers are hourly employees with little to no sick leave or benefits and may not be able to afford to get sick from side effects. Certified nursing assistants, who make up the overwhelming majority of care workers at nursing homes, make less than $15 per hour on average, and getting to work is often their top priority.

Now, the pressure is on the second round of nursing home vaccination clinics to reach those who’ve been missed. Both COVID-19 vaccines authorized in the U.S., from Pfizer and Moderna, require two doses administered up to six weeks apart. Missing a first dose during the second clinic will make it all but impossible for workers to get fully vaccinated through the on-site program. As Ohio Gov. Mike DeWine said in a December address to his state’s nursing home workers — of whom 60 percent were reportedly declining first doses — “The train may not be coming back.”

Rina Shah, group vice president of pharmacy operations and services at Walgreens, said in a press briefing that the pharmacy is developing tools to get long-term care workers vaccinated once the program ends. One possibility, she said, is supplying vaccine vouchers to workers who can then take them to a Walgreens clinic to receive a shot. But doing so may put those workers in large queues with millions of members of the general population who are struggling to secure vaccinations.

Mike Wasserman, past president of the California Association of Long Term Care Medicine — which represents doctors, nurses, pharmacists and others in the industry — says the current program needs to be more accommodating. “Instead of a one-size-fits-all, rigid approach,” he says, what’s needed is a “more flexible plan that might allow the facility to do its own vaccinations over the course of a week.”

That could also prevent staffing shortages that may arise from inoculating too many workers with second doses at one time. In the Pfizer and Moderna vaccine trials, participants reported feeling worse side effects — mainly fatigue, headache, muscle aches, chills, joint pain and possibly some fever — after their second dose, which could lead to lots of staff calling in sick at once, straining a facility’s ability to look after residents at a time of national staffing shortages.

Anecdotal evidence from second-round clinics now taking place suggests that vaccine uptake among staff is improving. The Associated Press reported that last week, in a meeting on vaccine policy, Amanda Cohn, the CDC’s deputy director of immunization services, said more staffers get vaccinated when a second or third clinic is held at a home. And a CVS spokesperson told USA Today that they are seeing a higher uptake by staff members on their second visits.”  (D)

“Anxious about taking a new vaccine and scarred by a history of being mistreated, many frontline workers at hospitals and nursing homes are balking at getting inoculated against Covid-19.

Anxious about their patients’ health and scarred by many thousands of deaths in the past year, hospitals and nursing homes are desperate to have their employees vaccinated.”

Those opposing forces have spawned  an unusual situation: In addition to educating their workers about the benefits of the Covid-19 vaccines, a growing number of employers are dangling incentives like cash, extra time off and even Waffle House gift cards for those who get inoculated, while in at least a few cases saying they will fire those who refuse.

Officials at two large long-term care chains, Juniper Communities and Atria Senior Living, said they were requiring their workers, with limited exceptions, to take the vaccine if they wanted to keep their jobs.

“For us, this was not a tough decision,” said Lynne Katzmann, Juniper’s chief executive. “Our goal is to do everything possible to protect our residents and our team members and their families.”

Critics say it is unethical to strong-arm low-paid workers into taking the vaccines, especially when there hasn’t been enough time to gather long-term safety data.

“This is a population of people who have been historically ignored, abused and mistreated,” said Dr. Mike Wasserman, a geriatrician and former president of the California Association of Long Term Care Medicine. “It is laziness on the part of anyone to force these folks to take a vaccine. I believe that we need to be putting all of our energy into respecting, honoring and valuing the work they do and educating them on the benefits to them and the folks they take care of in getting vaccinated.”” (E)

(A)Nursing homes make big push to change minds of workers who refused vaccination, by Suzy Khimm, https://www.nbcnews.com/news/us-news/nursing-homes-make-big-push-change-minds-workers-who-refused-n1254509

(B) Only 38% of nursing home workers accepted COVID-19 vaccines, new data shows, by Karen Weintraub, https://www.usatoday.com/story/news/health/2021/02/01/nursing-home-workers-reluctant-get-covid-vaccine-cdc-study-finds/6664743002/

(C) Why Are So Many Health-Care Workers Resisting the COVID Vaccine?, By Dhruv Khullar, https://www.newyorker.com/science/medical-dispatch/why-are-so-many-health-care-workers-resisting-the-covid-vaccine

(D) Less Than Half of Nursing Home Workers Got COVID Shots in First Round, CDC Says, by Emily Paulin, https://www.aarp.org/caregiving/health/info-2021/nursing-home-workers-refuse-vaccine.html

(E) Cash, Breakfasts and Firings: An All-Out Push to Vaccinate Wary Medical Workers, By Rebecca Robbins, Sabrina Tavernise and Sharon Otterman, https://www.nytimes.com/2021/01/14/business/covid-vaccine-health-hospitals.html