Ashish K. Jha is dean of the Brown University School of Public Health.
This should not have to be the case. While dozens of health systems have started to mandate vaccinations for employees, far too many have yet to take that step even though 1 in 4 hospital workers who have contact with patients remain unvaccinated. It is far past time for these organizations to require vaccines for all workers.
Health care is the only business that, as a matter of course, is full of immunocompromised people for whom vaccinations often fail to provide adequate protection. For these medically vulnerable people, health systems must be the safest place possible. Indeed, the Hippocratic oath to “first do no harm” demands it.
Some organizations have suggested that they will only require mandates for staff who work explicitly with such patients. That isn’t enough. It is hard to tell who is immunocompromised and who isn’t. Plus, hospital staffing must respond to the unpredictable vagaries of demand. Nurses may be assigned to different units on short notice; doctors may have to provide an urgent consult for a new cancer patient. It is not reasonable or feasible for clinical care to accommodate the vaccine status of clinical staff.
Fortunately, there is no set of workers with better access to vaccines, with shots available on demand at hospital employee health centers. Many hospital workers are already vaccinated; now hospitals must take steps to ensure that all employees are vaccinated and their patients are protected.
Health systems should follow the lead of Houston Methodist Hospital, which announced in early April that all staff would need to get vaccinated. The hospital faced a storm of protest from a small minority of employees who didn’t want to get vaccinated. This vocal resistance obscured how smoothly the vaccine mandate was implemented. Of nearly 25,000 workers, more than 99 percent got vaccinated. Those who didn’t were initially suspended, prompting many more to get the shot. A tiny fraction — 153 employees of 25,000 — were dismissed or resigned.
One of those recalcitrant staff members sued the hospital, saying that vaccine mandates violated their rights. A federal judge held otherwise, saying “This is not coercion. It is a choice made to keep staff, patients and their families safer." This ruling should provide comfort and support to other hospitals as they roll out vaccine mandates to keep patients safe.
Even with this judgment, successfully implementing such a mandate will require more than a simple decree. For doctors and nurses, who are accustomed to vaccine mandates for diseases such as measles and flu, clear directives should be enough, especially if they come with potential consequences for not complying. But for other hospital employees — such as food service workers and nurse’s aides — hospitals should take a more thoughtful approach: They should consider, for example, providing a day’s paid leave after each shot. They should also conduct education and outreach programs, in which senior clinical leaders respond to employee questions and concerns about the vaccines and the mandate. One concern that is often raised is that these vaccines have only been authorized under emergency use. But given that hundreds of millions of people have already received them, it is clear they are safe and effective.
Health-care leaders will also need to take broader action. Some of the holdouts from Houston Methodist are reported to have moved to private clinics, which simply relocates the risk they pose. Here, the American Hospital Association and state hospital associations have a key role to play. They should encourage the formation of coalitions that mandate vaccines in health-care markets, much as health-care organizations in Massachusetts — including Mass General Brigham, Beth Israel Lahey and Wellforce — that jointly announced following Houston Methodist’s success.
Several states have passed or are working on legislation to ban employers from requiring proof of vaccination as a condition of employment. Setting aside the broader objection to these laws, they are morally indefensible when applied to health-care systems, which have always required employees to have a set of vaccinations. Enforcement of such a rule would prevent hospitals from doing what they know is necessary to keep patients safe. Hospitals and health systems should be exempted, as many of these laws would do.
In 2021, the responsibility of every hospital to the health and safety of its patients means protecting vulnerable patients from covid-19. Patients shouldn’t have to worry that being in the hospital puts them at risk for serious disease. The best way to do that is to ensure that everyone who comes into contact with patients is vaccinated.
Coronavirus: What you need to know
The latest: The CDC has loosened many of its recommendations for battling the coronavirus, a strategic shift that puts more of the onus on individuals, rather than on schools, businesses and other institutions, to limit viral spread.
Variants: BA.5 is the most recent omicron subvariant, and it’s quickly become the dominant strain in the U.S. Here’s what to know about it, and why vaccines may only offer limited protection.
Vaccines: Vaccines: The Centers for Disease Control and Prevention recommends that everyone age 12 and older get an updated coronavirus booster shot designed to target both the original virus and the omicron variant circulating now. You’re eligible for the shot if it has been at least two months since your initial vaccine or your last booster. An initial vaccine series for children under 5, meanwhile, became available this summer. Here’s what to know about how vaccine efficacy could be affected by your prior infections and booster history.
Guidance: CDC guidelines have been confusing — if you get covid, here’s how to tell when you’re no longer contagious. We’ve also created a guide to help you decide when to keep wearing face coverings.
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