Why we don't know how many Chicago area medical workers haven't been vaccinated, and why it matters

More than three months into a massive COVID-19 vaccination campaign that started with people who work in hospitals, clinics and nursing homes, local officials in the Chicago area don't know how many healthcare workers have been inoculated.

Although anecdotal evidence suggests more than 160,000 across Illinois might still be unvaccinated, the actual number is unknown. A related unknown: Which members of the healthcare workforce haven't been vaccinated.

Knowing the number and identities of unvaccinated healthcare workers is "essential" to understanding our vulnerability to COVID, says Dr. Emily Landon, the executive medical director for infection prevention and control at the University of Chicago Medicine. "It's hard for humanity to get back to normal without knowing who's vaccinated."

That information gap impedes the COVID fight in important ways. Though hospitals and clinics maintain strict COVID protocols, they might unwittingly assign unvaccinated workers to COVID wards, potentially furthering viral spread. Public health agencies can't target vaccine promotion efforts to the unvaccinated and learn whether workers are hesitant to get shots, or just having a hard time scheduling vaccination appointments. And patients can't evaluate the level of risk in various health care settings.

While they do require reporting on age, race and ZIP code, federal and state authorities have not required vaccinators to gather employment information from people who get vaccines. Some national data exists distinguishing between resident and staff vaccinations at nursing homes, but neither Walgreens nor CVS (which are managing those campaigns in Illinois) collects that information.

Crain's asked Chicago's largest hospital systems about their staff vaccination rates. The average for those that responded was just under 70%. That's short of the 81% of healthcare workers who got flu shots during the 2018-2019 season, according to the federal Centers for Disease Control & Prevention.

At the beginning of the vaccine rollout, the state estimated that Illinois had 540,000 healthcare workers, ranging from physicians, nurses and dentists to lab, dietary and security workers. If 70% have been inoculated, 162,000 remain unvaccinated. Not knowing who or where those unvaccinated workers are makes it difficult to connect them with vaccine appointments, which are still difficult to come by as eligibility has expanded to more people.

"My personal opinion is that we need to figure out where the vaccines haven't been given: in healthcare, in neighborhoods, among older people, in nursing homes, in every setting where it's important, every high-risk or front-facing community," Landon says.

The picture is even murkier at independent medical and dental practices where workers and patients still face high risk, says Dr. Vineet Arora, the CEO and co-founder of Illinois Medical Professionals Action Collaborative Team, or IMPACT.

"When I take my daughter to the dentist, no one at that practice has been vaccinated. I went to an eye doctor recently. None of the front desk clerks have been vaccinated yet," Arora says.

While hospitals are tracking overall staff vaccination data internally, they face sticky privacy pitfalls. Hospital workers are required as a condition of work to get their flu shots, but because the COVID-19 vaccine was approved under emergency use by the U.S. Food & Drug Administration, it isn't similarly mandated. Despite the vaccine's proven efficacy, the emergency use authorization "creates uncertainty for anybody getting the vaccine, and legal uncertainty as to an employer's liability," says professor Michael LeRoy, who teaches labor and employment relations at the University of Illinois College of Law.

Federal health privacy law bars management from seeing staff vaccination records in some workplaces. Disclosure is also a hot button for unions, which have objected to mandatory flu shots in the past.

"There's not a clear answer about whether it's OK to track whether an individual has their vaccine," Landon says. "Many hospitals have avoided even having people wear stickers that say they've been vaccinated, because they don't want to make unvaccinated people feel bad, they don't want to have any coercion or make people feel they're somehow different."

"To protect our employees' privacy, we do not share individual or small-group COVID-19 vaccination information," a UChicago Medicine spokesperson says. "Instead, we analyze our institution's overall vaccination rate as well as broad, department-level statistics to better identify certain work areas that may need additional support."

As of March 11, 72% of UChicago Medicine's 14,800 employees have either received at least one dose of vaccine or scheduled a vaccination appointment. The hospital hosted town halls and smaller work unit huddles to try to boost rates further.

Dr. Vishnu Chundi, a senior partner at Metro Infectious Disease Consultants and the chair of the Chicago Medical Society's COVID task force, says his practice is considering asking unvaccinated workers to double mask or wear N95s going forward if they've chosen not to be vaccinated. But moving unvaccinated workers to lower-risk tasks is difficult, he says. "It's not like there's a ton of people who know how to do neurosurgery or anesthesia."

Rush University Medical Center reported one of the highest vaccination rates. As of March 9, 80% of clinical staff and 77% of all employees had received shots. "At the outset, we didn't have a specific target besides getting as close to 100% as we can, understanding we'd likely land closer to between 60 and 80%," says Dr. Paul Casey, Rush's chief medical officer. The hospital is tracking who has been vaccinated, telling the unvaccinated how they can get a shot, and offering to address any questions or concerns.

The city also asked Rush to vaccinate about 3,000 healthcare workers. By March 9, the hospital had vaccinated or scheduled 2,300 of those people. But Casey says Rush has no way to know how many of the 700 who haven't responded might've gotten vaccinated elsewhere.