POST 175. July 5, 2021. CORONAVIRUS. “Can a health care worker who is not against vaccines in general still harbor sincere concerns that scientists don’t yet know about all the side effects of these vaccines? Yes, says Ezekiel Emanuel, MD, PhD — but those people should not work in health care.”
The president and CEO of Springfield, Mo.-based CoxHealth :”If you are making wildly disparaging comments about the vaccine, and have no public health expertise, you may be responsible for someone’s death. Shut up.” (G)
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“Florida’s largest public and private hospitals have no immediate plans to require employees to get vaccinated for COVID-19 and, in many cases, can’t or won’t say how many of their front-line staffers have been inoculated against the deadly virus.
The state’s health center workers — many of whom are subject to flu shot requirements — commonly do not even have to disclose their vaccination status, even if they work closely with patients at high risk of complications, a USA TODAY Network-Florida review of public and private hospital policies has found.
As a result, patients using scores of Florida hospitals have no way of knowing whether doctors, nurses or anyone else they interact with, have been vaccinated. And even those hospitals that have estimates on vaccination rates commonly say they don’t know the status of half of their employees.
Take the Lee County-based Lee Health hospital system, one of the state’s largest public health care organizations and the site of Florida’s first known COVID-19 death. Its representatives say they do not know the vaccination status of more than 40% of its 13,500 employees. Shots are not required or even need to be reported, though they are mandated annually for far less deadly influenza viruses…
Nearly all of the one dozen health care organizations in Florida that reporters contacted in June don’t require vaccinations — all citing the newness of the vaccines. One known exception is Johns Hopkins Medicine, which operates Johns Hopkins All Children’s Hospital in St. Petersburg. It announced earlier this month that it would require all medical and non-medical staff to be vaccinated by Sept. 1.
Of those that provided estimates of staffers fully vaccinated, rates ranged from 51% to 67%…
The lack of strict vaccination rules, and the lack of transparency about them from private operators in Florida, comes in a state whose Republican governor signed an executive order against any vaccine mandates and recently pardoned Floridians who violated local COVID-19 safety ordinances.
Federal regulations do not prohibit employers from requiring vaccinations, according to the Equal Employment Opportunity Commission…
One recent poll speaks to the current sentiment: Kaiser Health News and The Washington Post found that just over half of all front-line healthcare workers had been vaccinated and that roughly a third were unsure whether they’d ever get the shots…
Despite the risk to healthcare workers and their patients, none of the main lobbying groups for hospitals, doctors and/or nurses are calling for mandates.
National Nurses United, the nation’s largest nursing union with 7,000 Florida members, refused to comment for this story. The Florida Hospital Association released a statement saying it won’t comment on individual hospital vaccination policies, even though it encourages people to get their shots.
The American Medical Association’s president, Gerald E. Harmon, released a statement putting it this way: “While vaccines are highly effective public health tools, vaccine mandates are a blunt instrument and may carry the risk of eroding trust and undermining public health goals.”..
Still, the federal Occupational Safety and Health Administration earlier this month published new rules to protect workers from COVID-19, a threat it called a “grave danger.” They include rules on social distancing, mask-wearing and allowing employees time to get vaccinated….
They stop short of requiring vaccinations, however…“ (A)
“Can a health care worker who is not against vaccines in general still harbor sincere concerns that scientists don’t yet know about all the side effects of these vaccines? Yes, says Ezekiel Emanuel, MD, PhD, professor of medical ethics and health policy at Perelman School of Medicine at the University of Pennsylvania — but those people should not work in health care.
“We don’t force anyone to go into a health care profession,” explains Emanuel, co-author of a New York Times commentary arguing that vaccines should be required for all health care workers. “When you go into medicine, part of what you’re signing up for is, ‘I’m going to put my patients first.’”
While rejecting medical treatment is a matter of individual liberty, he says, people must sometimes yield when that refusal can harm those around them by spreading a severe and potentially fatal disease. “The idea that ‘it’s my body and it affects only me’ is just not true,” he says.
On that principle of protecting patients, staff, and their families, many health care facilities require staff to get flu shots each year. In 2009, the swine flu pandemic prompted some hospitals to institute vaccination mandates for health care workers.
The new COVID-19 vaccination requirements, however, typically cover all workers — even those who do not work in patient care or who are employed by outside companies that provide such services as food preparation and security. That’s because just about everybody working in a health care facility comes within close vicinity of patients, visitors, and colleagues, Boom explains. At UPHS, Brennan adds that “in order to be equitable, we had to require it for everyone. Everyone has the same rules of employment.”
That said, the policies do provide procedures for people to apply for exemptions and deferrals based on medical conditions, religious beliefs, and pregnancy. (The EEOC also covers exemptions in its updated guidance.)
Why not wait? At this point, the vast majority of hospitals are doing just that, hoping that several developments will make mandates more palatable or even unnecessary.
One such development would be the FDA granting full approval to any of the three COVID-19 vaccines. That decision might prompt more staff to get inoculated voluntarily while also giving health systems more scientific backup for mandates.
EUAs are granted on a temporary basis for treatments that have been shown to be safe and effective in initial clinical trials when sufficient alternatives do not exist. Full, permanent approvals require companies to collect data on their treatments’ effects on thousands of people over longer periods (typically six months or more). Moderna and Pfizer — the makers of the first two vaccines to be granted EUAs — have applied for full approval, which might come this fall.
Fall is too late for some health leaders. They worry that the cooler weather, reopening of schools, and seasonal retreat of more people back indoors might fuel the spread of the disease.” (B)
“When vaccines first became available in December under an emergency use authorization, hospitals reported that they planned to wait until the U.S. Food and Drug Administration granted full approval of the vaccines before deciding whether to make the shots mandatory.
But in recent weeks, dozens of hospitals and medical groups in Indiana, Maryland, New Jersey, New York, Pennsylvania, Washington, D.C., and elsewhere began issuing vaccination requirements. Public health law experts say the moves are a legal means of ensuring a safe, COVID-19-free environment for patients and workers.
Requiring health care workers to get shots makes sense for liability reasons, said James Hodge Jr., a law professor at Arizona State University and director of the Network for Public Health Law’s Western Region Office. He said hospitals and other medical groups run a serious legal risk if a patient becomes infected from contact with an unvaccinated worker.
A growing number of hospitals are beginning to make the vaccine mandatory for workers, with some religious and medical exceptions, the American Hospital Association said in a statement emailed to Stateline. But some are waiting until the FDA fully approves the shots and more safety and efficacy data becomes available…
Beyond any legal issues, medical workers in all settings have an ethical and professional obligation to protect their patients by getting a COVID-19 vaccination, said Dr. William Schaffner, professor of preventive medicine at Vanderbilt University School of Medicine and medical director for the National Foundation for Infectious Diseases.
He said he wasn’t surprised that hospitals were starting to require the vaccine with only emergency authorization by the FDA, or that the Texas court upheld the mandate. “We’ve given this vaccine to close to 70% of the U.S. population and the data indicates that its efficacy and safety are holding up very strongly.”… (C)
With our policy having stood this legal test, we believe that other employers can use our process for developing a vaccination policy of their own. It consists of seven steps.
1. Establish an ethical framework and hierarchy.
To guide us while making our policies, we defined a “pyramid of responsibility,” with patients and their families at the top, followed by our employees, and the Houston community forming the base. This framework was developed through a scientific and ethical review of Covid-19 vaccine research, which established our institutional responsibility under the precepts of beneficence (a procedure should only be performed with intent of doing good for the patient) and non-maleficence (a procedure should not harm the patient or others in society)….
2. Conduct a risk-benefit analysis compliant with professional standards.
The first step is to conduct a risk-benefit analysis of vaccination versus no vaccination. Critically, this analysis must be performed by subject-matter experts who can accurately assess the situation.
Our risk-benefit analysis asked one question: Do the available vaccines reduce the risk of harm from a Covid-19 infection more than they increase the risk of severe adverse reactions? The vaccines approved under the U.S. Food and Drug Administration’s (FDA’s) emergency use authorization are highly effective…
3. Ensure that policies for religious and medical exemptions are consistent with public health recommendations and state and local laws.
4. Provide a robust educational campaign.
Educate individuals throughout the organization on the risk and benefits of vaccination versus non-vaccination. Transparently explain the process you employed to create your policy. Make an extra effort to listen to the concerns of employees who are hesitant to be vaccinated and address their concerns. Education has multifold advantages over compulsion…
5. Combat misinformation.
Houston Methodist worked throughout the pandemic to counteract misinformation. In town halls and emails, we continually shared updated scientific information and proactively identified and corrected misinformation. Feedback showed that employees greatly appreciated this transparent communication.
6. Lead by example.
Before asking non-management workers to comply with the mandate, it is crucial for them to see that managers were compliant with this policy. At Houston Methodist, the deadline for executives and other managers to be fully vaccinated was approximately two months prior to the one for all workers.
7. Monitor the vaccination rates.
By measuring vaccine rates over time and sharing the impact of vaccination policies, you can demonstrate that the policy is equitably applied and is an institutional priority. Health care workers are more likely to voluntarily receive vaccines and comply with vaccine policies when they observe others complying with the institutional policies.” (D)
“Leaders of Mass General Brigham, Beth Israel Lahey Health, Wellforce, and Dana-Farber Cancer Institute said requiring vaccination for employees is critical for protecting vulnerable patients, especially those who are immunocompromised.
Together, these hospital systems employ more than 135,000 people. All employees, including those who don’t work directly with patients, must get vaccinated, though they can request exemptions for medical or religious reasons…
Hospital leaders did not set a deadline for employees to be vaccinated. They said they would wait until the US Food & Drug Administration grants full approval of the vaccines, which could take weeks or months. (The FDA has authorized the vaccines for emergency use.)…
Dr. Kevin Tabb, chief executive of Beth Israel Lahey, said his health system has a responsibility to protect patients and employees, and that it must lead by example.
“We’re an institution that is based on science,” he said in an interview. “We know the vaccine is extraordinarily effective, and we know that it’s safe. … We stand on much stronger moral ground asking others to get vaccinated when we ourselves have been vaccinated.”
At Wellforce, the hospital system that includes Tufts Medical Center, executives sent an e-mail to employees saying: “COVID-19 is still with us. The Delta variant is becoming more prominent in the United States, and it is vitally important that we continue to do everything we can to protect our patients and ourselves.”
Dana-Farber Cancer Institute told its employees: “Because our patients are especially vulnerable, we will strictly enforce compliance.” Cancer patients are at greater risk because they may have weakened immune systems from their treatments…
In requiring the COVID vaccine, Massachusetts hospitals are following the lead of those in other states, including Texas, Maryland, and New York…
Governor Charlie Baker, asked about the vaccination mandates Thursday, said, “As far as I’m concerned, that’s their call.”
“At this point in time, I would prefer to let organizations make the decisions they think are going to keep their people safest,” Baker said at an appearance in Quincy. “But different people are in different places with respect to this, and I think we should respect that as well.” (E)
“A large hospital system’s decision to mandate the COVID-19 vaccine for its 48,000 workers in New York state could forge a path for other employers to potentially require the shots.
Indeed, experts anticipate the NewYork-Presbyterian hospital network’s move last week to require employee vaccinations could trigger a wave of similar mandates within the state’s health care system and beyond…
The New York State Nurses Association, which represents more than 42,000 nurses statewide, has also taken a stance against vaccine mandates for employees in general while supporting calls for voluntary COVID-19 vaccination.
The nurse union’s opposition is in part based on the fact the COVID-19 vaccines have emergency-use authorization, rather than full federal approval. A federal judge, however, recently upheld a Texas hospital system’s employee vaccine mandate, offering the first legal precedent for the policy.
The high-stakes debate over vaccine mandates is unfolding as New York on Monday reached its goal of partially vaccinating 70% of adults, despite struggles to reach some health care workers, communities of color and rural areas with shots.
A total of 72% of hospital workers in New York state have been fully vaccinated, while nursing homes lagged with just 63% of workers at least partially vaccinated, state data show.
But the vaccination effort has all but stalled in some hospitals. It is a trend that prompted many health networks to consider mandates to vaccinate all workers amid the threat of future COVID-19 outbreaks in communities with low vaccination rates, experts and trade groups said.
Health care settings have historically been on the front lines of the politically charged debate over vaccine mandates in New York.
For example, hospital workers are currently required to prove immunity against measles and rubella under state law. Hospitals must also track employees’ flu vaccination status and require unvaccinated staff to wear masks in most settings during flu season.
In announcing the COVID-19 vaccine mandate, NewYork-Presbyterian’s executives touted it as a means to build upon its existing vaccine requirements that already “keep patients and workers safe” from other diseases.
The statement underscored how the COVID-19 vaccine mandate could provide the massive health system, which includes hospitals in New York City and the Hudson Valley, a competitive edge in marketing its 100% vaccinated status.
In contrast, hospitals with large shares of unvaccinated workers would face the prospect of spending staff and financial resources on frequently testing them for COVID-19, said Wendy Darwell, president and CEO of the Suburban Hospital Alliance of New York State.
“High vaccination rates also significantly reduce the risk of workforce shortages, something we’ve struggled with in New York throughout the pandemic,” she added.” (F)
Connecticut’s 27 acute care hospitals are moving to adopt a policy requiring staff members to be vaccinated against COVID-19, following dozens of other hospitals and health systems nationwide that have implemented the mandate.
The edict gained momentum last month after a federal judge dismissed a lawsuit against Houston Methodist that challenged the hospital’s vaccine requirement for workers. Houston Methodist was one of the first hospitals in the U.S. to mandate that staff be inoculated against the coronavirus. One hundred and seventeen unvaccinated employees brought the suit, saying it was illegal for management to demand that workers get the shot.
The dismissal cleared the way for many others to implement the requirement. Hospitals in New York, Massachusetts, Maryland, Indiana, New Jersey, Pennsylvania and other states have imposed the rule. And it has raised questions about whether other health care facilities, such as nursing homes, federally qualified health centers, private practice physicians and community clinics, will be compelled to join them.
In Connecticut, discussion around the policy began two months ago and culminated recently in an announcement by the state’s hospital association that all of the facilities would soon require COVID-19 vaccinations for their staff. The move was agreed upon by hospital leaders.
“There are some patients now who are asking, ‘Is everyone coming in and out of my room vaccinated? Are the clinical staff vaccinated?’ Certainly it’s a concern for patients,” said Paul Kidwell, senior vice president of policy for the Connecticut Hospital Association, which is helping to develop the mandate. “We want to be able to tell our patients that we’ve done everything we can to make sure they are protected from COVID.” (H)
“Amid low vaccination rates among healthcare personnel and after residents of a nursing home in the Landes region of France were infected with the Delta variant of Covid-19, the French government is pushing forward with plans to require those working in the health sector to take the jab.
To prevent similar incidents in the future, legislation is currently being drafted that would require those who work in hospitals or nursing homes to take the Covid-19 vaccine. Prime Minister Jean Castex said Wednesday that he would begin consultations on the subject “in the coming days”.
“I am, like all French people, shocked…when we see the epidemic reintroduced…through those whose vocation is to protect and care,” Castex said. “This is not acceptable.”
In the nursing home cluster, one of several in the region, 23 residents – 21 of whom had been fully vaccinated – and six staff members were infected with the variant. Nineteen of the cases were identified as the Delta variant. Three of the residents were hospitalized, but none was admitted to intensive care…
Currently, less than 60 percent of nursing home workers and less than 64 percent of hospital workers have been vaccinated, according to Alain Fischer, the government’s point man on vaccination. “This is clearly insufficient,” he told the weekly newspaper, the Sunday Journal (JDD). “They must do it to protect patients. It is a principle of responsibility and example setting.”
Fischer said he thought the legislation should apply to anyone in contact with the public. He said he feared that insufficient vaccination rates throughout the country could lead to a fourth wave of the pandemic in France. And he reminded that a single dose of a two-dose vaccine does not provide ample protection.
The Hospital Federation of France (FHF) is in favour of compulsory vaccination for workers who come in contact with the public. The Synerpa, one of the main federations representing private nursing homes, is also in favour of compulsory vaccinations.” (I)
- A.Florida hospitals don’t require, and often aren’t even aware of, staff COVID-19 vaccinations, by Frank Gluck, https://www.news-press.com/story/news/2021/06/24/florida-hospital-staff-covid-19-vaccination-numbers-continue-lag/7634591002/
- B.Should hospitals mandate COVID-19 vaccination?, Patrick Boyle, https://www.aamc.org/news-insights/should-hospitals-mandate-covid-19-vaccination
- C.Hospitals Start Requiring Workers to Get COVID Shots, By Christine Vestal, https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2021/06/21/hospitals-start-requiring-workers-to-get-covid-shots
- D.How to Develop a Covid-19 Employee Vaccination Policy, by by Susan M. Miller, Robert A. Phillips, Roberta L. Schwartz, H. Dirk Sostman, Carole Hackett, and Marc L. Boom, https://hbr.org/2021/07/how-to-develop-a-covid-19-employee-vaccination-policy
- E.State’s largest health care providers to require all employees get COVID-19 vaccines, By Priyanka Dayal McCluskey, https://www.bostonglobe.com/2021/06/24/metro/states-largest-health-care-providers-will-require-all-employees-be-vaccinated-against-covid-19/
- F.A NY hospital mandated COVID vaccines. Will other hospitals, businesses be next?, by David Robinson, https://www.lohud.com/story/news/coronavirus/2021/06/16/covid-vaccine-mandate-new-york-hospitals-businesses/7706725002/
- G.Missouri hospital CEO: People spreading COVID-19 vaccine misinformation should ‘shut up’, by Hannah Mitchell, https://www.beckershospitalreview.com/hospital-management-administration/missouri-hospital-ceo-people-spreading-covid-19-vaccine-misinformation-should-shut-up.html
- H. Connecticut hospitals are requiring staff to get vaccinated against COVID. Will other health providers follow?, by JENNA CARLESSO, https://ctmirror.org/2021/07/05/ct-hospitals-are-requiring-staff-to-get-vaccinated-against-covid/
- I.France to consider requiring Covid vaccines for healthcare workers, by Monique El-Faizy, https://www.france24.com/en/france/20210704-france-to-consider-requiring-covid-vaccines-for-healthcare-workers
PREQUELS
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.
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.
POST 169. June 14, 2021. CORONAVIRUS. “Hospitals in Washington, D.C…announced a consensus agreement to mandate COVID-19 vaccinations for more than 30,000 workers, 70% of which are already vaccinated. Each of 14 hospitals will set their own deadline…”
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