When Penn Medicine announced its vaccine mandate May 19, the health system didn't do so because it had received guidance from professional medical societies or national trade associations.
At the time, they hadn't made any.
"Professional societies' positions have not come into play honestly. Not many have staked out a position," said Dr. Patrick Brennan, chief medical officer and senior vice president of the University of Pennsylvania Health System, which is part of Penn Medicine. "It's not that it didn't matter. We would have liked to have them on board."
Instead, the health system convened an interdisciplinary working group, made up of legal counsel, clinicians, administrators, human resources representatives and nurses.
"We came to a conclusion pretty quickly," Brennan said.
Across the country, hospitals and health systems have had to take that plunge on their own, without guidance from medical societies or major associations like the American Hospital Association or the American Medical Association on whether to mandate the vaccine. That falls in stark contrast to their stances on the flu vaccine, which associations like the AHA support being mandatory.
"They fall in an interesting place. They're representing a very wide group of people, much broader than any individual hospital. That's clearly part of the political reason why it's difficult for a mandate on vaccines," said Andy Challenger, senior vice president at Challenger, Gray & Christmas, an executive outplacement firm.
Most associations have put out statements strongly in favor of vaccination efforts, but have shied away from recommending actual mandates, save for the Association for Professionals in Infection Control and Epidemiology, which on June 30 publicly shared its support for hospitals and health systems that are requiring employees and clinical workers to be vaccinated against COVID-19 as a condition of employment.
"Because voluntary vaccination policies are not always effective in achieving acceptable vaccination rates, many healthcare organizations opt to require them as a condition of employment. Those that do see dramatic increases in their vaccination rates," APIC President Ann Marie Pettis said in a statement. "Vaccination is the single most effective strategy we have to stop the spread of this virus, including the more dangerous variants, and to prevent needless suffering, hospitalization and death."
At Penn Medicine, about 71% of healthcare workers had been vaccinated before the mandate was announced. Today, about 75-80% are, Brennan said.
"It would be great if more medical societies took a position," Brennan added.
Michelle Hood, executive vice president of the AHA, said the association has heard from a "growing number" of hospitals that are already mandating vaccine and also from other hospitals that plan to do so once the vaccines receive full approval from the FDA.
"The AHA has not taken a position on mandating vaccines for healthcare workers but we continue to talk with our members about the issue," Hood said.
Likewise, the Dr. Gerald Harmon, new president of the AMA, told Modern Healthcare that while the association "strongly recommends" healthcare workers get the vaccine, it is "letting the individual organizations make that decision." The high vaccination rates among doctors, Harmon said, show that physicians are taking a leadership role in vaccination efforts.
"We're voting with our feet," Harmon said.
A recent study by the AMA shows that about 96% of practicing physicians in the U.S. have been fully vaccinated against COVID-19, but that survey had a relative small sample size of 301 physicians.
The American Nurses Association does not explicitly support vaccine mandates for nurses but ANA President Dr. Ernest Grant said, "ANA does not support any exemptions from immunization other than for medical contraindications and does not endorse philosophical or religious exemptions.
"ANA also firmly believes it's imperative for everyone to receive immunizations for vaccine-preventable diseases when possible for the reason that vaccines are critical to infectious disease control and prevention. Moreover, nurses have a professional and ethical obligation to model the same health care standards they prescribe to their patients," Grant said.
The National Rural Health Association said it does not have a position at this time, and the Federation of American Hospitals did not respond to a request for comment.
Some associations may be trying to avoid conflict that could detract from the message of getting vaccinated, Challenger said.
"When you think about it, if you're thinking about a medical association…they do not want to start a fight between healthcare workers that don't want to get vaccinated and their employer because I also think they care about the broader issue, which is getting more people vaccinated," Challenger said.
At Houston Methodist, the first hospital in the U.S. to implement a COVID-19 vaccine mandate, a group of 117 workers sued the health system, claiming it was "forcing its employees to be human 'guinea pigs' as a condition for continued employment" and was violating the Nuremberg Code, which prohibits human experimentation. That lawsuit was thrown out by a federal judge, but the debate resulted in major headlines.
"It's complicated because it's not purely a medical issue. It's also a political issue. Even associations are deciding to stay out of the fray," Challenger said.
Some of those same concerns were raised at Penn Medicine.
"There are some vocal opponents. As much as they're trying to conflate noise with numbers, I don't think there are great numbers," Brennan said. Instead, "The mandate has gotten some people off the fence," he added.
Ultimately, the system made its decision based on science and the system's mission to protect patients and staff, Brennan said. The technology that was used in the messenger RNA vaccines was created there, and the system has a lot of insight and awareness of the vaccines.
"Patient safety is our value, and we're going to put a stake in the ground on that." he said. "We hear from patients that they want to know their providers have been vaccinated."