As more healthcare organizations impose requirements for their employees to get vaccinated against COVID-19, support for mandates among the country's leading labor groups has been mixed.
Unions such as National Nurses United and the National Union of Healthcare Workers endorsed employer vaccine mandates, so long as workers voices are formally heard when policies are developed. Others, including the Service Employees International Union, have withheld support so far, and contend that these requirements present complex questions that go beyond a simple "yes" or "no" response.
These unions share a common principle: Even mandates for the sake of public health should not supersede workers' rights.
Over the course of the pandemic, healthcare worker unions have been at the forefront of efforts to improve worker safety, including enhancing infection-control practices and ensuring adequate supplies of safety equipment.
Those same labor organizations now find themselves in the precarious situation of promoting vaccinations among their members while opposing what some feel is an attempt by employers to circumvent labor rules that require them to negotiate with workers before making changes to their terms of employment and working conditions.
Critics of employers requiring vaccinations contend worker input is crucial for developing policies to enhance access and increase immunizations. In addition, some union contracts don't allow employers to change workplace rules unless companies negotiate with unions.
"We have a legal right to be part of the process, to bargain over the effects over any new work rule," said Debbie White, president of Health Professionals and Allied Employees, the largest union of healthcare professionals in New Jersey, which represents more than 14,000 employees.
Many of the largest health systems in recent weeks have instituted vaccine mandates for their employees in an effort to slow the spread of the virus among both workers and patients. Such requirements have gotten support from a number of municipal, state and federal government leaders. President Joe Biden is requiring federal workers either attest they have been vaccinated or be subject to weekly testing and mandatory masking.
Mandatory vaccinations also have support from major medical professional organizations, including the American Medical Association, the American Academy of Nursing, and the American College of Surgeons, which last week put out a joint statement calling for healthcare workers to be required to get vaccinated as a condition of their employment. The American Hospital Association and other organizations representing health systems also back vaccine mandates.
Federal law allows employers to require all employees physically entering a workplace to be vaccinated for COVID-19. Individuals with medical reasons and religious objections can be exempt from complying to an employer's mandatory vaccination policy, and so can some workers protected by the Americans with Disabilities Act.
Unionized employees could also be exempt from vaccination requirements if their collective bargaining agreements require their employers to first negotiate the terms of a new policy affecting working conditions.
Health Professionals and Allied Employees has voiced support for vaccinations but has concerns about employer mandates because those policies were imposed without negotiations with workers. "This is a new working condition, so we absolutely have the right to bargain over the effects," White said.
About one in four hospital workers who have direct contact with patients had yet to receive a single dose of a vaccine by the end of May, according to an analysis conducted by WebMD and Medscape Medical News in June. WedMD and Medscape analyzed HHS data on 2,500 hospitals that had vaccination rates ranging from 30%-99%. At the 50 largest facilities, about one-third of workers were unvaccinated.
National Nurses United, which represents more than 170,000 workers, has always supported vaccine requirements as long as there were exemptions made for those who opt out for religious and medical reasons, said Jean Ross, the union's president. In the meantime, nurses in the union still face many of the same safety problems they've experienced since the early days of the pandemic, such as personal protective equipment shortages, she said.
The fact that the vast majority of new COVID-19 infections, hospitalizations and deaths are among those who are unvaccinated has justifiably prompted stakeholders to focus much of their response effort on getting more people vaccinated.
The focus on worker vaccinations, however, essentially shifts the responsibility for ensuring a safe working environment from employers to individual employees, Ross said.
"Our fear is that even if we don't have the best equipment, even if there's not enough of it, or even if we are asked to reuse it like they made us do before, they can say, 'At least you're vaccinated,'" Ross said.
The Service Employees International Union, the largest labor group in healthcare with 1.1 million members, declined to state a position on vaccine mandates. In a statement, the union emphasized that employers must do more to improve access to vaccines. SEIU is convening with leaders of its locals as well as community groups to chart a path forward, the union said.
Such sentiment speaks to the lack of trust many unions harbor for employers after more than a year of working under dangerous conditions, which has contributed to the hesitancy of some unions to voice support for vaccine mandates, even in the face of a public health emergency.
"Pre-vaccine, we could not get hospitals across the board to test workers even if they had symptoms," said Sal Rosselli, president of the National Union of Healthcare Workers, which represents 15,000 members in California.
The union itself adopted a vaccine mandate for employees and visitors to its offices three months ago, Rosselli said.
The National Union of Healthcare Workers has entered negotiations with a couple of hospitals over the past two months over their terms of their vaccination mandates, Rosselli said. The union reached tentative agreements with employers that members later ratified. Under these arrangements, workers are given access to vaccines at their job sites and employers must cover all costs associated with the immunization and provide paid time off for employees who suffer side effects from the shots.
Union members at Kaiser Permanente are set to begin deliberations within days on how to respond to the Oakland, California-based integrated health system's new vaccine mandate, which requires all 240,000 workers to be fully vaccinated by Sept. 30.
Worker perspectives are crucial to the parties adopting policies with which they're both comfortable. "It's too bad more employers do not check with their workforce when there is not a union present in a facility," White said. "That could only enhance not only the relationship between the employer and the employees, but it could provide some very needed input."