with Alexandra Ellerbeck

Dear readers: 

As The Post’s beloved editor Ben Bradlee said, “It changes your life, the pursuit of truth.” It has certainly changed mine as I’ve written The Health 202 over the past 4½ years. I’ve composed at least 800 editions of the newsletter since we first launched it, exploring a wide range of topics inside the wild (and sometimes bewildering) world of health policy. It's been an immense privilege to follow these stories wherever they lead and share them with you.

Thank you from the bottom of my heart for staying with me through it all — and please stick around, because we’re not going anywhere! While this is my last edition of The Health 202 as full-time author (I'll now be editing the newsletter), I leave you in excellent hands with the superlative Rachel Roubein, who brings a wealth of experience, insight and, most importantly, curiosity to the job. Rachel joins us from Politico, where she has reported on health care for nearly a decade. Watch for her byline — and more about her — on Tuesday. 

The Biden administration will require nursing home workers to get vaccinated against the coronavirus, and there’s a possibility hospital staffers could be next.

The reasoning is clear: Medical workers should be protected from passing the virus to the most vulnerable Americans — particularly as the delta variant refuels the pandemic. And the nation's largest network of nursing homes has already instituted its own vaccine requirement for staff.

Yet the major nursing home associations are pushing back, saying they shouldn't be singled out and raising concerns about worsening staff shortages over the mandate.

The Department of Health and Human Services will use its funding leverage over long-term care facilities.

The administration said yesterday it will develop rules requiring nursing homes to mandate that all of their workers be vaccinated as a condition for those facilities to receive federal funds, The Post’s Tyler Pager and Annie Linskey report.

HHS, which is developing the new regulations, will enforce them with the threat of withholding Medicare and Medicaid dollars — the major source of funding for more than 15,000 nursing home facilities, which employ roughly 1.3 million workers.

Larry Levitt, senior vice president at the Kaiser Family Foundation, noted it's not the first time the government has taken this tactic:

“If you visit, live or work in a nursing home, you should not be at a high risk of contracting covid from unvaccinated employees,” Biden said.

President Biden announced on Aug. 18 that all care home workers will be required to be vaccinated against coronavirus. (The Washington Post)

As my colleagues previously noted, the effort “is part of a far more muscular approach by the Biden administration to increase vaccinations amid spiking cases due to the highly contagious delta variant.” Indeed, coronavirus cases have shot up in parts of the country in recent weeks, while deaths — albeit rising more slowly — are back to levels seen in May, about 620 per day.

Nursing homes said they want their staff vaccinated – but they also don't want to be singled out.
  • LeadingAge, which represents nonprofit providers of aging services, said penalizing nursing homes “is not the right way to increase vaccination rates.”
  • The leading group representing long-term care providers complained that the administration was singling out nursing homes and should have instead applied the mandate more broadly to other health providers. “Unfortunately, this action does not go far enough,” Mark Parkinson, president of the American Health Care Association and National Center for Assisted Living, said in a statement. “Vaccination mandates for health care personnel should be applied to all health care settings. Without this, nursing homes face a disastrous workforce challenge.”

The fear Parkinson was articulating is that health-care workers — whose vaccine hesitancy rates are similar to those among the general public — might choose to leave their job rather than get the shots. And that could intensify personnel shortages that are already a problem across the country. 

Ninety-four percent of nursing homes surveyed by AHCA said they are experiencing a staffing shortage. Hospitals are experiencing nursing shortages — and lately those have been particularly apparent in areas where the coronavirus is especially surging, as our colleague Amy Goldstein recently reported.

“They've got PPE and other supplies,” Chip Kahn, president of the Federation of American Hospitals, told me. “The big problem is staffing, and so the question is: does this get in the way of staffing?”

There are some examples of this happening in hospitals.

Earlier in the summer, more than 150 health-care workers were fired or resigned from the Houston Methodist hospital system for refusing to comply with its vaccination requirement. New Jersey’s largest hospital system fired a half-dozen workers who also refused to get vaccinated.

Nursing homes are starting to shift in the direction of mandates, too. A few weeks ago, Genesis Healthcare told workers they need to get the shots in order to keep their jobs. The decision was a major shift for the industry, given that Genesis has 400,000 employees in nearly 400 nursing homes and senior communities.

Of course, these examples don’t prove that a federal vaccine requirement would lead to widespread hospital staff losses. The Associated Press recently interviewed operators of 10 smaller nursing homes, who said that fears of a massive staff exodus seem to be overblown. But it’s a fair question to ask, considering long-standing concerns in the United States over lacking enough medical workers as the population ages.

Medical workers are (surprisingly?) hesitant to get vaccinated.

One might guess they would be more willing than the general public to get the shots, but that doesn’t seem to be the case, especially when it comes to lower-wage workers such as medical aides and assistants.

Medscape Medical News found 1 in 4 hospital workers who have direct patient contact hadn’t received a single coronavirus vaccine dose by the end of May, when it analyzed government data from 2,500 hospitals around the country.

In a March poll conducted by The Post and the Kaiser Family Foundation, 30 percent of front-line medical workers said they either wouldn’t get a vaccine or hadn’t yet decided whether to get one. The poll found vaccination rates were higher among doctors and nurses compared with those who perform administrative duties or assist with patient care.

And hundreds of thousands of nursing home workers still aren’t vaccinated. Only about 62 percent of nursing home staff members in the United States were vaccinated as of Aug. 8, ranging at the state level from a low of 44 percent to a high of 88 percent, according to data from the Centers for Medicare and Medicaid Services. 

Christina Jewett, investigative reporter for Kaiser Health News:

A similar mandate could be on the way for hospitals.

Yesterday’s new vaccination requirement doesn’t include hospitals, but health-care lobbyists said the administration has been toying with the idea of extending similar requirements to them. A CMS spokeswoman declined to comment on the matter.

Many hospitals have decided on their own to press forward on vaccine mandates. About one-third of hospitals have announced mandatory vaccination policies for their workers so far, a spokesman for the American Hospital Association told me. When asked for a response to the nursing home requirements, AHA emphasized its support for hospitals making their own decisions.

“The AHA supports hospitals and health systems that choose, based on local factors, to mandate covid-19 vaccines for their workforce,” the statement said. 

Ahh, oof and ouch

AHH: The Biden administration will make booster shots available starting Sept. 20.

Officials say that American adults who received the Pfizer-BioNTech and Moderna vaccines can receive a booster shot eight months after their second dose, although the plan is dependent on approval from the Food and Drug Administration and advisers to the Centers for Disease Control and Prevention. People who received the Johnson & Johnson vaccine probably will also need boosters, but officials are waiting on more data, The Post’s Hannah Knowles, Ben Guarino and Laurie McGinley report.

President Biden said on Aug. 18 that after Sept. 20, vaccinated Americans can get booster shots against coronavirus eight months after their second injection. (The Washington Post)

The decision was influenced by studies showing that protection offered by vaccines declined in the midsummer months when the more contagious delta variant rose to dominance. One study in New York found that the effectiveness of the vaccines in protecting against coronavirus infection dropped from 92 percent in May to 80 percent in late July. Still, officials have stressed that the vaccine continues to offer robust protection against hospitalization and death.

“You want to stay ahead of the virus. … You don’t want to find yourself behind, playing catch-up,” said White House medical adviser Anthony S. Fauci.

OOF: Critics say the CDC has been too slow to share data.

Senior administration officials and outside experts are voicing a growing frustration with what they see as the CDC’s slow and siloed approach to sharing data, saying it has prevented officials from getting clear, real-time information on the pandemic and has stymied the nation’s response to the delta variant, The Post’s Yasmeen Abutaleb and Lena H. Sun report.

“Critics lament that the most up-to-date data about the delta variant has come from other countries, such as Israel, Great Britain and Singapore. And they say the CDC’s inability to share real-time information led top administration officials, including the president himself, to offer overly rosy assessments of the vaccines’ effectiveness against delta that may have lulled Americans into a false sense of security, even as a more wily and formidable variant was taking hold,” our colleagues write.

Health officials repeatedly reassured people throughout July that 99.5 percent of deaths from covid-19 were among the unvaccinated, but that data was based on the first six months of the year, before the delta variant became dominant. The CDC has not yet released updated numbers.

The CDC “will tell us just how bad this delta wave was with beautiful science in four months, published in JAMA,” said Scott Gottlieb, a former FDA commissioner and a Pfizer board member, referring to the prestigious medical journal. “It’s not an indictment of them. It’s the wrong agency. Their mind-set is we should polish it, vet it, peer-review it.”

OUCH: Hospitals are again in crisis mode as they struggle to respond to a fourth wave of the coronavirus.

In the week ending Tuesday, 46 of the 50 states experienced double-digit growth in covid-19 hospitalizations, according to an analysis by The Post.

“The impact on hospitals is at once distressingly familiar and strikingly different from previous surges, clinicians say. In addition to handling mounting covid-19 case numbers, hospitals are playing catch-up on elective surgeries that were postponed because of the pandemic. People are out driving on the roads and playing sports, experiencing accidents and injuries, and increasing the burden on trauma departments,” The Post’s Frances Stead Sellers, Ariana Eunjung Cha, Hannah Knowles and Derek Hawkins report.

Health-care workers are also burned out, which has made hiring harder. They are treating deathly sick patients who are younger than before and who almost certainly would not be in the hospital if they had been vaccinated.

“It’s kind of like running a race. We knew the finish line was a vaccine. Now, whoop, there is another half-marathon in front of you,” said Lisa Clark Pickett, chief medical officer at Duke University Hospital in North Carolina. “We have seen so much death, and now it’s young people dying of things we can prevent.”

More in coronavirus news

Biden ordered the Education Department to take action against governors who ban mask mandates in schools.

The president said in a news conference that the administration would not “stand by” and allow governors to prevent districts from “keeping students safe” with masking mandates, The Post’s Valerie Strauss reports. Republican Govs. Ron DeSantis of Florida, Greg Abbott of Texas and Doug Ducey of Arizona are among those who have  threatened to withhold funding or take action against districts that require masks.

“I’m directing the secretary of education to take additional steps to protect our children,” Biden said. “This includes using all of his oversight authorities and legal action if appropriate against governors who are trying to block and intimidate local schools officials and educators.”

Elsewhere in health care

Pelosi reaffirmed her commitment to passing H.R. 3.

House Speaker Nancy Pelosi (D-Calif.) vowed to pass Democrats' signature drug pricing legislation in remarks at the San Francisco General Hospital on Wednesday. Pelosi said that she is hoping to get the bill, which would enable the federal government to negotiate lower drug prices, into Democrats' upcoming $3.5 trillion budget reconciliation package.

“It’s outrageous that Big Pharma gets away with charging drug prices in the United States that they do not charge anywhere else in the world,” Pelosi said.

Drug companies are vehemently opposed to the plan. A spokesperson from PhRMA, an industry group, accused Pelosi of “pushing a drug pricing plan that will ultimately jeopardize access to prescription medicines and stifle the development of new cures.’ 

The Sacklers are threatening to pull out of a major opioid settlement unless they are guaranteed legal immunity.

David Sackler, a member of the family that owns Purdue Pharma, vowed in court on Tuesday that the family would back away from a $4.5 billion pledge to help communities devastated by the opioid crisis, unless a judge grants the family sweeping immunity from current and future lawsuits, the New York Times’s Jan Hoffman reports.

Planned Parenthood is running a six-figure ad campaign targeting Texas's impending “heartbeat” law.

This week the group launched a $150,000 paid advertising campaign in Texas, Arizona, Georgia, Kentucky, Michigan and Mississippi. The social media and website ads will target a new Texas law that  bans abortions near the beginning of pregnancy. The law's text says “a physician may not knowingly perform or induce an abortion on a pregnant woman if the physician detected a fetal heartbeat for the unborn child.” 

“'Sue thy neighbor,’ Texas-style abortion bans could be coming to our backyards,” Planned Parenthood's Heather Holdridge said in a statement. “More than 25 million people — at least 7 million of them in Texas alone — are in danger of losing abortion access from these and other attacks.”

The Texas law — set to take effect Sept. 1 — also allows any private citizen to sue abortion providers or anyone who helps a woman get an abortion after a fetal heartbeat has been detected. More than 20 abortion providers are suing the state over the law, which is similar to other state laws blocked by courts.

Sugar rush