The statement and accompanying guidelines — signed by the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America and five other medical groups — come amid a raging debate about health care, as some organizations impose new vaccine requirements and as infectious-disease expert Anthony S. Fauci suggested last weekend that “there should be more mandates” at the local level to curb virus spread.
But federal officials have balked at instituting national requirements on health-care workers, and many health-care organizations have said they do not plan to require their staff members to get vaccinated against the coronavirus. Some nurses and other health-care personnel have quit or sued organizations that imposed coronavirus vaccine mandates, claiming that the measures are unethical or illegal, although a federal judge rejected one such lawsuit last month.
The guidelines announced Tuesday — which include recommendations for engaging wary employees, navigating regulations and how to enforce a mandatory coronavirus vaccination policy — were crafted by a team of nearly 30 experts during the past two months.
“We think [it] will provide support for organizations that were thinking about making the vaccine a condition of employment for their health-care workers,” said Hilary M. Babcock, an infectious-disease expert at Washington University School of Medicine in St. Louis and a past president of the Society for Healthcare Epidemiology of America, who co-wrote the guidelines.
Although cases of covid-19, the disease caused by the virus, have plunged nationally, Babcock said the vaccine push remains a priority, pointing to a new outbreak in her state driven by the delta variant.
“If this [variant] isn’t affecting your local community, the next one potentially might,” she said. “It is still a good practice to try and get all health-care workers vaccinated so that they are protected.”
Outside experts agree that vaccine mandates are warranted, more than a year into the pandemic and with tens of millions of adults still refusing to get vaccinated despite the wide availability of shots.
“One thing that really upsets me is we’re hitting a wall,” said Paul A. Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, lamenting that national vaccination rates have stalled and that the virus continues to spread. “What do you do then? And I think the only answer to that question is you compel people to vaccinate. It’s certainly legal. It is not your inalienable right as a U.S. citizen to catch and transmit a potentially fatal infection.”
A number of health systems, including in Maryland and D.C., have moved to require coronavirus vaccines for their employees, arguing that they are essential to protect staff and vulnerable patients. The strategy has boosted vaccination rates: More than 2,000 employees at the University of Pennsylvania Health System in Philadelphia have received shots since the system announced in May that it would require all staff members to be vaccinated by September, said Patrick J. Brennan, the system’s chief medical officer.
But many other organizations have balked, noting that the vaccines have yet to receive full approval from the Food and Drug Administration. The American Hospital Association — which has repeatedly called for mandatory flu shots for health-care workers — has yet to weigh in on coronavirus vaccine mandates. The hospital organization said it is continuing to consult with members and clinical experts on the path forward.
“Let’s be honest,” said Ashish K. Jha, dean of Brown University’s School of Public Health, “some health systems are bold and creative, but a lot of them just want to stay below the headlines and just do their thing and don’t want to be courageous. And right now, this feels courageous because they know they’re going to get some pushback from some small minority of employees, and they’d rather not take that on.”
Jha, who has argued that the Hippocratic oath “demands” that health workers get vaccinated, said holdout hospitals’ concerns were probably overblown, citing the example of Houston Methodist. More than 97 percent of that hospital system’s workers complied with a vaccine mandate, with about 2 percent requesting exemptions and the remaining 153 workers getting fired or resigning last month.
“If hospitals do it in concert … the number of health-care workers who will quit and move is pretty tiny,” Jha predicted. “You’re not going to have 20 percent of health-care workers move out of a city or a state.”
But Jha said he was concerned to learn that some of the unvaccinated workers who left Houston Methodist had been hired by other institutions. “The risks that they pose have now been transferred from Houston Methodist to other institutions,” he said. “The organizations that are stepping up and saying, ‘We’ll hire unvaccinated front-line health-care workers’ … I find [that] a bit more puzzling.”
Some prominent children’s hospitals, such as Boston Children’s Hospital and Children’s Hospital of Philadelphia, have yet to require their staff members to be vaccinated, despite treating many patients who are not yet eligible to receive vaccines. The FDA has yet to authorize coronavirus vaccines for children younger than 12.
Jha said he was disappointed that children’s hospitals had not led the way on vaccine mandates.
“Children’s hospitals literally have a vast majority of their patients unvaccinated — and yet, most children’s hospitals that I’m aware of have not mandated this,” he said. “That strikes me as particularly stunning. And I don’t understand that.”
Offit, who is helping to craft vaccine policies at Children’s Hospital of Philadelphia, said he expects more holdout organizations to move forward with vaccine requirements, including his own.
“We are going to mandate this vaccine, that’s going to happen, [but] I suspect it’s probably not going to happen until these vaccines are approved, which will be soon,” he said. “We just found a lot of the people who were resistant for that reason, even though it’s a bad reason.”