POST 167. June 9, 2021. CORONAVIRUS. Hospitals prevaricate on mandatory staff vaccinations. Florida’s Governor forbids cruise ship vaccine mandates. Pfizer and Moderna apply for FDA full approval.

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“U.S. employers could require all workers physically entering a workplace to be vaccinated against Covid-19, the federal government said Friday.

The Equal Employment Opportunity Commission issued updated guidance stating that federal laws don’t prevent an employer from requiring workers to be vaccinated.

However, in some circumstances, federal laws may require the employer to provide reasonable accommodations for employees who, because of a disability or a religious belief, aren’t vaccinated. For example, the EEOC said as a reasonable accommodation, an unvaccinated employee entering the workplace might wear a face mask, work at a social distance or be given the opportunity to telework.

The new guidelines also say that federal laws don’t prevent or limit incentives that can be offered to workers to voluntarily take the vaccine. And employers that are administering vaccines to their employees may also offer incentives, as long as the incentives aren’t coercive.

The updated guidance is intended to answer frequently asked questions, EEOC Chairwoman Charlotte Burrows said in a statement. She said the agency will continue to update and clarify its assistance for employers.” (A)

“After more than a year of online classes, regular coronavirus tests and mask mandates, most of the nation’s colleges are gearing up for what passes for a normal return to campus in the fall.

The widespread availability of COVID-19 vaccines is making that possible, but colleges are likely to remain wary. Though nearly half of adult Americans are fully inoculated, only about 30% of 18- to 24-year-olds have reached that benchmark, according to data from the Centers for Disease Control and Prevention.

College students pose a high risk to efforts to control the pandemic. Last September, counties home to universities suffered many of the nation’s worst COVID-19 outbreaks. But colleges are determined to find ways to resume full, in-person courses. Students and professors struggled with online learning, and universities lost revenue tied to in-person costs such as dorms, meal plans and even athletics.

So some colleges will require students to provide proof they received COVID-19 vaccines. Here’s what you need to know about those requirements – and exceptions to them.

How many colleges will require a COVID-19 vaccine?

So far, about 400 or so colleges plan to require that students who wish to learn in-person receive the Johnson & Johnson, Moderna or Pfizer shots, according to a list compiled by the Chronicle of Higher Education.

Both public and private universities have issued coronavirus vaccine mandates for students, though state colleges in Republican-controlled states have been more likely to eschew such requirements. The American College Health Association, a trade group of college health care providers, recommended colleges require the vaccine for in-person  classes where “state law and available resources allow.”

So what happens when the FDA fully approves one of the vaccines?

Expect to see more universities require whichever vaccine is approved first. The University of California and the California State University systems have already said they would require coronavirus shots, but only when a vaccine is fully approved. New York Governor Andrew Cuomo issued a similar directive to public universities in New York. The California and New York systems are some of the largest in the country, and other universities are likely to follow their lead.” (B)

“Milloni Doshi, a 25-year-old student from India who is supposed to start her master’s degree this fall at Columbia University’s School of International and Public Affairs, has a problem.

Although Ms. Doshi has been vaccinated against the coronavirus, she received two doses of Covaxin, which is made by an Indian manufacturer and is not currently approved by the World Health Organization, as required by the university.

Columbia has told her she will need to be revaccinated with a different vaccine once she arrives on campus, but no one can say for sure if it is safe to do so.

“I am just concerned about taking two different vaccines,” she wrote via a messaging app. “They said the application process would be the toughest part of the cycle, but it’s really been all of this that has been uncertain and anxiety-inducing.”

Since March, more than 400 colleges and universities in the United States have announced vaccine mandates, requiring students to be immunized against the coronavirus. But the rules have been designed primarily with domestic students in mind, leaving international students scrambling — particularly those in India and Russia.

Neither Covaxin nor the Sputnik V vaccine, which is manufactured in Russia, has been approved by the W.H.O. American students, however, have access to the Pfizer-BioNTech, Moderna and Johnson & Johnson vaccines, three of the eight authorized by the health agency, according to a W.H.O. spokesman.

The disparity could hinder colleges that have made it a major priority to retain international students, who brought in close to $39 billion in tuition dollars in the year before the pandemic, according to one analysis.

“Universities want to enroll international students because they add diversity to the campus community — and they bring money,” said Terry W. Hartle, senior vice president at the American Council on Education. “It’s why this has been a subject of intense discussion.”

The situation is particularly challenging for students in India, which sends approximately 200,000 international students to American colleges every year, the second most after China. The subcontinent is emerging from the grips of one of the most severe waves of the pandemic, when burial grounds were running out of space and funeral pyres were nearly constantly burning. Vaccine shortages are so acute that only 3 percent of the population is fully immunized, and getting an appointment is a taxing affair…

The Centers for Disease Control and Prevention has tried to provide guidance. The agency considers people fully vaccinated several weeks after they have received the requisite doses of any of the vaccines authorized by the W.H.O., said a spokeswoman, Kristen Nordlund.

Besides the three vaccines currently available in the United States under emergency authorization by the F.D.A., the world body has, according to its website, also approved three versions of the AstraZeneca vaccine, including one made in England and one made in India; the Sinopharm vaccine, which is manufactured in China; and, as of this week, the Sinovac vaccine, also made in China.

Many universities appear to be following these guidelines: “If a student has had a W.H.O.-approved vaccine,” said Clayton S. Rose, the president of Bowdoin College, “then the student will be considered to be vaccinated.”

At Columbia, where one-third of the student body is from overseas, international students will be asked to present either their W.H.O. booklet or a letter from a physician confirming they have received the requisite doses of one of the vaccines vetted by the world body, said Donna Lynne, the chief operating officer of the university’s medical center, who heads the campus’s Covid-19 response…

There are those who will not succeed in securing a vaccine before the start of the fall semester. Bowdoin and many other universities say they plan to have clinics on campus that will offer one of the three F.D.A.-authorized vaccines.

The trick is that two of those — Pfizer and Moderna — require the first and second dose to be spaced three weeks apart; because someone is only considered fully vaccinated two weeks after the last dose, the process lasts a minimum of five weeks. During that time, will students be required to quarantine while the rest of campus goes back to normal? Will they need to undergo routine testing?

Campuses are proposing different measures, with some saying that those students will need to self-isolate in their dorm and attend classes remotely. Others are saying the students will be expected to wear a mask and undergo testing.

The more complicated scenario is if students received a vaccine that has not been approved by the W.H.O., like Sputnik or Covaxin. Many colleges are proposing that those student will need to be revaccinated, which presents both medical and logistical conundrums.

No data exists on whether combining vaccines from different companies is safe.

“Since Covid-19 vaccines are not interchangeable, the safety and effectiveness of receiving two different Covid-19 vaccines have not been studied,” Ms. Nordlund, the C.D.C. spokeswoman, wrote in an email.

She added that the C.D.C. was recommending that people who were vaccinated outside the United States with a vaccine that was not authorized by the W.H.O. should wait a minimum of 28 days before taking the first dose of one of the F.D.A.-sanctioned vaccines.

Many universities were vague on how they plan to deal with the logistical complexity of spacing out these unrelated vaccines, beyond saying that they planned to accommodate students undergoing this process.

While much remains in flux, at least one major university system is planning on deviating from the C.D.C. guidelines.

California State, the largest public university system in the country with 23 campuses enrolling nearly a half-million students, plans to accept any vaccine a student received if it was authorized by the regulatory agency in their country of origin, said Chancellor Joseph I. Castro.

“They will be able to satisfy the requirement,” he said, “as long as the vaccine they receive is approved by something similar to an entity like the F.D.A.””  (C)

“Which cruise lines have added a vaccine requirement?

Cruise lines that have announced a COVID-19 vaccine requirement for all or at least some upcoming cruises include American Cruise Lines, Celebrity Cruises, Crystal Cruises, Cunard Line, Disney Cruise Line, Holland America, Norwegian Cruise Line, Oceania Cruises, Princess Cruises, Regent Seven Seas Cruises, Royal Caribbean, Silversea, Virgin Voyages and Windstar Cruises.

Lines that are restarting operations without requiring passengers to show proof of a COVID-19 vaccine include MSC Cruises, Uniworld Boutique River Cruise Collection, and German lines TUI Cruises and Hapag-Lloyd Cruises.

Lines that have yet to make a decision on a COVID-19 vaccine requirement include The Ritz-Carlton Yacht Collection.

Instead of making a COVID-19 vaccine mandatory for cruising, some lines are requiring that passengers show proof of a negative COVID-19 test before boarding a ship.

Some lines, such as Lindblad Expeditions and Disney Cruise Line, are requiring both proof of a COVID-19 vaccine and proof of a negative COVID-19 test.

Other lines, such as Avalon Waterways and Uniworld Boutique River Cruise Collection, are requiring either proof of a COVID-19 vaccine or proof of a negative COVID-19 test.

Most of the lines that have not yet announced a policy regarding COVID-19 vaccinations have suggested they will announce one closer to the date when they restart operations.” (D)

“Florida Governor Ron DeSantis announced Thursday, April 8, he is suing the CDC in an effort to get cruises restarted immediately. Legal experts call it a political stunt.

Gov. Ron DeSantis’ bid to get cruise safety rules from the U.S. Centers for Disease and Prevention thrown out has hit another bump. On Thursday, DeSantis’ office said the two sides failed to come to an agreement during mediation as part of the governor’s lawsuit against the agency.

A federal judge in Tampa will now decide whether to invalidate the CDC’s conditional sail order — a set of rules and recommendations cruise companies are using to get cruises restarted in the U.S. as soon as June 26. Even if the judge rules in DeSantis’ favor, a recently passed Florida law championed by DeSantis that bans companies from requiring patrons be vaccinated against COVID-19 will still prevent cruises from Florida to take place as planned.

Vaccine requirements are part of some companies’ safety protocols meant to prevent outbreaks and deaths that plagued ships last year. DeSantis sued the CDC on April 8, arguing that the agency’s conditional sail order unfairly targeted the cruise industry and should be thrown out. None of the cruise companies have joined DeSantis’ lawsuit.

In a press release Thursday, DeSantis falsely claimed that the CDC is requiring cruise passengers to be vaccinated. In reality, the CDC recommends, but doesn’t require, that all cruise passengers, crew and port personnel be vaccinated. The CDC allows cruise ships that decide to require at least 98% of their crew members and 95% of their passengers to be vaccinated to restart cruises from U.S. ports. Ships that don’t meet those thresholds can restart after doing a two-day test cruise to make sure COVID prevention protocols are working in the vaccine’s absence…

While the governor’s legal dispute with the CDC continues, vaccination requirements are at the top of the list of new protocols cruise companies have put in place while cruises in the U.S. have been halted since March 2020.

The new plans aim to prevent life-threatening missteps made in the early days of the pandemic. In one case, a ship that had a passenger test positive for COVID-19 after a previous cruise was allowed to unload thousands of passengers without any screening in Miami. In another, a passenger with serious respiratory distress died in a local hospital after waiting hours for an ambulance at the pier.

For the worst-case scenario — an onboard outbreak — companies have reserved in advance and will cover the cost of evacuating any sick passengers or crew members, depending on their condition.

PortMiami’s agreements with Royal Caribbean Group and Carnival Corporation — submitted to the CDC and reviewed by the Herald — show companies will primarily use embarkation day health declarations and testing to prevent the virus from getting on board cruise ships. They differ on vaccination: Royal Caribbean will require all crew and passengers who are 16 years old or older to be vaccinated, while Carnival will encourage everyone to get the vaccine, but not require it.

If an outbreak happens, the companies will isolate sick passengers and crew in designated cabins and wards in their ships’ medical centers to keep them away from others. The companies have contracts in place with transportation companies to transfer the sick, several local hotels to house them and hospitals to treat them if necessary. PortMiami will be in charge of cleaning cruise terminals, but if there’s an outbreak, that duty will fall to the cruise company.

If an infection happens outside the CDC’s jurisdiction, the agency’s guidance says the ship should submit a health declaration form to the port with jurisdiction.” (E)

“President Joe Biden on Friday indicated he may order all U.S. military forces to receive the coronavirus vaccine at a time of troubling voluntary acceptance rates among some troops, though it remains unclear whether he has the political mandate to do so and the White House itself seems uncertain about whether he could proceed in that direction.

“That is something the Department of Defense is looking at in consultation with the interagency process,” national security adviser Jake Sullivan said at an event Friday morning organized by the Aspen Security Forum, when asked by a reporter. “We don’t have anything to add on that subject here today.”

Sullivan’s comments came hours after the release of an interview with NBC News in which President Joe Biden said he had not ruled out requiring that all troops receive the COVID-19 vaccine.

“I’m not saying I won’t,” Biden said in response to a question about issuing a requirement to all U.S. service members.

Though most members of the military are required to receive a series of vaccinations and other shots as a part of their service, the Defense Department is not at the present time mandating they receive the coronavirus vaccine because it is currently under emergency authorization by the Food and Drug Administration.

“We are offering the COVID-19 vaccine on a voluntary basis in accordance with the emergency use authorization,” Pentagon spokesman Army Maj. Cesar Santiago tells U.S. News, noting that all members of the military have been eligible to receive the vaccine since April 19. “When formally licensed by the FDA, the DoD may require a vaccine for military personnel or personnel in specific fields, as is the case for the influenza vaccine.”

When asked about the orders the White House is considering, Santiago says such a requirement would require “a waiver to make the vaccine mandatory.”

“The U.S. military has successfully continued operations and kept our forces safe during the pandemic by implementing other force health protection guidelines. We are focused on making the vaccine available as supply permits and do everything we can to inform and educate our people about vaccine safety and efficacy, so our service members can make an informed decision for themselves and their loved ones,” he says…

Legally, vaccines under emergency use authorization require service members to grant “informed consent” to receive one, which they are allowed to withhold. The law states a president may override that concern in the “interests of national security,” according to an analysis from Duke University’s Lawfire blog in February.

Robert Sanders, chair of the National Security Department at the University of New Haven, points to prior emergency circumstances during which the military required all service members to receive similar medical treatments – such as to protect against the threat of anthrax – which fell under military commanders’ specific authority to issue orders in the interest of safeguarding their troops. A follow-on case found that similar orders did not violate troops’ constitutional rights because, “The requirement to place the needs of the nation above a service member’s personal welfare applies in peacetime as well as in war.”

On the potential blowback from orders the Biden administration is considering, Sanders says, “I believe such challenges will fail on the merits under the history of the anthrax vaccine’s military litigation.”

However, as a growing number of private businesses and school districts begin enforcing vaccine requirements for patrons and students, it appears increasingly unlikely Biden would have cause to use emergency authorities to override the military’s current policy, particularly amid the president’s own goal of a “return to normalcy” or something like it by July 1.

The rate by which members of the various branches of the armed forces have opted to take the vaccine have ranged widely, and caused concern among the top echelons of the military to address the problem. For example, more than a third of U.S. Marines offered the shot have declined to take it. More than 92,000 have yet to be offered one.

Anecdotal evidence has pointed to concern among some – particularly those who are pregnant – about the safety of the vaccines themselves, while others appear to be refusing vaccinations solely because of the rare opportunity afforded to service members to say, “No.”

Adm. Mike Gilday, the Navy’s top officer, early this month said the Navy “can’t pressure anyone to take it,” so it has instead begun offering vaccines to crews when they are all assembled.

“Peer pressure,” Gilday said, “tends to bend things in a positive direction.”

Lt. Gen. Ronald Place, the director of the Defense Health Agency, said last week that commanders “have to be careful not to exert what we call ‘undue command influence.'” He stressed the safety of the 3.2 million doses the military had delivered at that time, despite concerns about negative side effects from the Johnson & Johnson vaccine, Place added that the military had experienced no instances of blood clotting or other disorders from the shots it had administered.

As of Wednesday, more than 147,000 Army soldiers have been fully vaccinated, along with more than 58,000 Marines, nearly 159,000 Navy sailors and 130,000 Air Force airmen, according to data the Pentagon began releasing this month.

The uniformed military has experienced almost 189,000 cases of coronavirus, in addition to 51,000 Defense Department civilians, 29,000 military dependents and 18,000 contractors. The Army comprises a third of all cases, and roughly double the case count for the Navy and Air Force.” (F)

More than half of New Yorkers are now fully vaccinated against COVID-19, but the Empire State – and the country as a whole – still has a long way to go when it comes to ending large-scale community spread. Vaccine hesitancy remains a key barrier to reaching the herd immunity that scientists say would require about 80% of the population get vaccinated. While state efforts to improve access and promote voluntary acceptance of COVID-19 vaccines remain ongoing, the state might eventually lean on legal mandates to boost immunity as it has for other diseases like measles and polio for decades.

A legal mandate could accomplish a lot even if it were not applied to the population at large. Vaccination rates among nursing home staff across the state still remain 20 percentage points below the herd immunity threshold, The New York Post reported May 9. And at some New York City nursing homes, most residents have not received a single shot. Gov. Andrew Cuomo recently announced that the governing boards at the City University of New York and State University of New York would require students to get vaccinated if they want to attend in-person classes this fall. What is stopping the state from requiring the same of other classes of people, whether they are nursing home staff, health care workers or the general public?

The current legal landscape surrounding the three available COVID-19 vaccines is a little tricky because they are currently administered under an Emergency Use Authorization from the U.S. Food and Drug Administration. That makes it tough to legally require that some people get their shots compared to others. Here is how it all works in practice.

Are vaccine mandates constitutional?

Yes. The U.S. Supreme Court ruled more than a century ago in Jacobson v. Massachusetts that state governments can impose vaccine mandates as long as they are reasonable and fairly enforced. A New York state court recently upheld the constitutionality of a 2019 law that eliminated religious exemptions for vaccines. The current U.S. Supreme Court could always rule otherwise, but the slow pace of the legal system means that would likely happen long after any future state vaccination requirements took effect in the near or medium terms.

So why is a vaccine mandate happening for public college students but not nursing home staff?

Guidelines from the federal Equal Employment Opportunity Commission make it clear that private employers can make vaccinations a condition of employment as long as the underlying rationale is “job-related and consistent with business necessity.” However, the FDA also requires that vaccine administrators give recipients a fact sheet that informs them of their right to refuse a vaccine. That creates a paradox of sorts for any public agency (like the New York City Police Department) or private business (like many nursing homes) that want to require vaccinations while also administering them under the Emergency Use Authorization. Colleges do not face the same problem when it comes to issuing mandates on students because their mandate is contingent on the FDA granting full approval to the vaccines by the fall.

The state could theoretically do the same for everyone else – just not until the vaccines are officially authorized. At least one public sector union leader has also noted how organized labor might also have to sign off on what type of disciplinary actions could be taken against vaccine scofflaws protected by collective bargaining agreements…

But wait… are vaccine mandates good policy?

Experts say sometimes yes, sometimes no. There were about 600 cases of the measles reported in the Empire State between October 2018 and July 2019, with 49 people getting hospitalized. While the full effects of the 2019 halt of the religious exemption for vaccines are still a matter of dispute, measles outbreaks have decreased to almost nothing over the past two years. However, public health experts say governments at all levels should exhaust their options before pursuing sweeping mandates. “When enforcement capacity is limited or nonexistent, mandates cannot be properly implemented and are thus unlikely to promote public health and safety,” Carmel Shachar, a bioethicist at Harvard Law School, and Dorit Rubinstein Reiss, a law professor at UC Hastings College of Law, wrote last year in the American Medical Association Journal of Ethics. “Moreover, mandates can backfire if a population resents being coerced and has not received sufficient education about the safety, efficacy, and public health importance of vaccinations.” The civil rights implications alone should make policymakers think twice before approving any future vaccine mandates, according to Allie Bohm, policy counsel at the New York Civil Liberties Union, unless they do everything they can to make sure that vaccine mandates do not exacerbate existing political, social, economic and racial divisions. “How do you know you’re making sure that you’re enforcing fairly and that you’re enforcing evenly?” she said in an interview. “It’s another really important thing to think about.”” (K)

“New York City won’t mandate coronavirus (COVID-19) vaccines in public schools for the 2021-2022 school year, Mayor Bill de Blasio said Tuesday.

During his press conference, de Blasio was asked by reporters if the city would mandate the vaccine for students and staff for next school year. New York State announced Monday it would require college students in State University of New York (SUNY) and City University of New York (CUNY) schools get inoculated for the fall semester.

“No across the board,” de Blasio said, about whether the city would require vaccinations for students and staff in public schools. “We are seeing extraordinary success right now in our schools, and this is before we’ve been able to vaccinate our kids…But no, the schools have been incredibly safe because of all the safety measures, that gold standard of health and safety measures we put together. I’m really excited about the fall, I think we’re going to be in much, much better shape than we’re in now in terms of the overall COVID situation.”

He added he looks forward to welcoming back “every single student” to public schools next school year, with health and safety measures in place. The goal for the 2021-2022 school year, de Blasio has repeatedly said, is “five-day-a-week education in-person.”

And there will likely be many students and staff vaccinated by then, de Blasio said during the press conference.

The decision to not mandate the shot comes after discussions with the city’s health team.

“We just don’t think it’s the right way to go at this moment,” de Blasio explained. “We’ll always be led by the data and science but right now, we’re seeing extraordinary success and we expect that success to be sustained. And there’s lots of — four months to get lots and lots of people vaccinated. I think we’re on the right track. If anything changes, we will certainly be open to making adjustments.”

The city Department of Education (DOE) said last week that there is currently no mandate in place for students to get the COVID vaccine. However, the agency is encouraging all eligible students and staff to get vaccinated at one of the many sites across the city.

The DOE said it will continue to be guided by applicable local, state and federal laws.

With the exception of the flu vaccine for pre-K students, all student vaccination requirements are mandated by the state. The city mandates the flu vaccine for pre-K students.”  (L)

“Currently, all available vaccines in the United States have received only emergency use authorizations (EUAs) from FDA; none have been fully approved.

However, in December 2020, the Equal Employment Opportunity Commission (EEOC) said employers that mandated staff get vaccinated against Covid-19 would not violate federal disability law or civil rights statutes on discrimination, as long as they provided employees excluded from the workplace because of their vaccination status accommodations such as telework or leave and permitted exemptions for those refusing the vaccine on religious grounds.

And according to a poll conducted by the Washington Post and the Kaiser Family Foundation in April, nearly 60% of employed health care workers said they would support their organization mandating that all staff who work with patients get vaccinated.

However, the poll found that, among the roughly 30% of health care workers who said they did not plan to get vaccinated or had not yet made a decision, more than 80% said they would oppose their employer mandating the vaccine—and nearly two-thirds said they would rather quit their job than receive the vaccination. Among all employed health care workers, the poll found about one in six would leave their job rather than be vaccinated.


POST 163. May 23, 2021. CORONAVIRUS. RWJBarnabas Health in New Jersey announced a mandate…saying supervisors and those of higher rank must get the vaccine by June 30. They will eventually require the system’s 35,000 employees to do the same.

“…. other health care systems are holding off on such requirements, Becker’s Hospital Review reports, at least until FDA issues full approval for the vaccines.

“What we’re hearing from many hospitals is that they will likely make determination of requirement of the Covid-19 vaccine for their own employees at the time the vaccines receive full approval from the FDA, which has not happened yet, but will likely happen soon,” Nancy Foster, VP of quality and patient safety policy at the American Hospital Association, said.

For instance, Sentara Healthcare—a 12-hospital system with roughly 28,300 employees, about 66% of whom are at least partially vaccinated—said it is not yet going to mandate vaccination, in part because FDA has only authorized the vaccines.

“Do I believe there are any issues (with the vaccines)? No. But I don’t have the data at hand to be able to say to you as a person—let alone an employee—that I am going to mandate that you have it,” Jordan Asher, EVP and chief physician executive at Senatara, said. “I’m going to talk about the positives. But right now, I’m finding it difficult to create a mandate.”

Separately, Tracey Schiro—EVP and chief human resources officer at Ochsner Health, where roughly 55% of employees were vaccinated as of late April—said the system will not issue a vaccination mandate so long as the vaccines are only authorized, not fully approved, by FDA.

“In speaking with our CMO about the mandatory status, we feel that until there is FDA final approval, then we will continue to evaluate thinking about making it mandatory,” Schiro said. “Today, we do have the flu vaccine as a mandatory requirement unless someone has a medical or religious exemption, so once it’s approved by FDA, I think we’ll consider that and make our decision.”

In the meantime, Schiro said Ochsner was weighing whether, in lieu of a mandate, to offer employees financial incentives to get vaccinated. “We’re having executive discussions around an incentive based on what we’ve seen from peers across the country,” she said. “Some of our thinking is it may be something we want to put there for our employees to thank them for getting the vaccine and continuing to encourage people to get the vaccine” (Gooch, Becker’s Hospital Review, 5/19; Fernandez, Axios, 5/21; Penn Medicine News, 5/20; RWJBarnabas Health press release, 5/20; Brubaker, The Philadelphia Inquirer, 5/20; Washburn/Fallon,, 5/20).” (G)

“Amid the COVID-19 vaccine rollout, U.S. hospitals and health systems are considering whether to require their employees to get shots.

Houston Methodist has already decided to do so. The health system rolled out its mandatory vaccination policy March 31, with April 15 as the deadline for managers to receive at least one dose or get an exemption. More than 99 percent of the management team had complied by the deadline. By June 7, all 26,000 employees are required to have received the vaccine.

What are the considerations for mandates? 

One consideration is employee hesitancy or concern, addressed in a recent Washington Post-Kaiser Family Foundation poll-Kaiser Family Foundation poll.

The poll, conducted Feb. 11 to March 7, found that 58 percent of employed healthcare workers said they would support a mandate for employees who work with patients. Forty-two percent said they would oppose such a requirement.

Among employed healthcare workers who don’t plan to or have not decided to get vaccinated, 65 percent said they would leave their job if they were required to get vaccinated….

With these and other considerations in play, the process of deciding whether to mandate vaccination for employees remains fluid.

A small number of hospitals have made the vaccine mandatory with some exceptions, such as religious exemptions, said Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association. However, she said most association members indicated they will decide about requiring the shot for their own workers based on safety and efficacy data available at the time the vaccines receive full FDA approval.

“All hospitals and health systems are urging their staff and the general public to take the vaccine when it is their turn as an important step to provide additional protection from the serious consequences of COVID-19, both for themselves and for others, including the patients they care for,” said Ms. Foster.  

At Norfolk, Va.-based Sentara healthcare, a 12-hospital system with 28,300 employees, about 66 percent of staff had received at least the first vaccine dose as of April 20. Most are fully vaccinated, and the health system continues to have vaccination clinics for staff.

Right now, the health system has decided not to mandate the vaccine for employees, said Jordan Asher, MD, executive vice president and chief physician executive. He partially attributed the decision to the vaccines not being fully approved by the FDA, although he is a supporter of vaccines.

“Do I believe there are any issues [with the vaccines]? No. But I don’t have the data at hand to be able to say to you as a person — let alone an employee — that I am going to mandate that you have it,” said Dr. Asher. “I’m going to talk about the positives. But right now, I’m finding it difficult to create a mandate. On top of that, we’re in multiple states [Virginia and North Carolina]. You do have your own state regulations as it relates to labor law. You have to work through that simultaneously.”

As things change, though, he said Sentara continues to evaluate its decision and keep a close watch on guidance and directions from governing bodies such as the FDA.

Ochsner Health, a New Orleans-based health system with more than 30,000 employees, also decided not to mandate the vaccine for employees, as long as shots are only FDA-approved for emergency use. Tracey Schiro, executive vice president and chief human resources officer, said the organization could reconsider the decision after full approval.

“In speaking with our CMO about the mandatory status, we feel that until there is FDA final approval, then we will continue to evaluate thinking about making it mandatory,” said Ms. Schiro. “Today, we do have the flu vaccine as a mandatory requirement unless someone has a medical or religious exemption, so once it’s approved by FDA, I think we’ll consider that and make our decision.””  (H)

If you are visiting Medical Center Hospital, for the most part, you are no longer required wear a mask.

However, you’ll want to keep it handy because it is required in certain situations.

“We have removed masks,” Christin Timmons, MCH Chief Nursing Officer said. “We are highly encouraging masks to be worn, but we are not going to catch someone in our hallways and ask them to leave because they’re not wearing a mask. What we are requiring, is when a visitor is in a room with a patient, that they have a mask on. When our staff enters a room, they will have a mask on because we still need to protect those people in close areas.”

Not all hospital staff members have to wear them all the time, but they will have to in certain situations where they are in close contact with patients.

Children are still not allowed to visit patients.” (I)

“Moderna on Tuesday became the latest pharmaceutical company to apply to the U.S. Food and Drug Administration for full approval for its Covid-19 vaccine for use in people 18 and older. F.D.A. approval would allow the company to market the shot directly to consumers, and could also help raise public confidence in the vaccine.

Full approval could also make it easier for schools, employers, government agencies and the U.S. military, which has encountered resistance to coronavirus vaccines, to mandate vaccinations.

“We look forward to working with the F.D.A. and will continue to submit data from our Phase 3 study and complete the rolling submission,” Stéphane Bancel, Moderna’s chief executive, said in a statement.

Last month Pfizer and BioNTech applied to the agency for full approval of their vaccine for use in people 16 and older.” (M)


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