Rancorous opposition to vaccine mandates from a fraction of the hospital workforce has drowned out the voices of the administrators and staff who desperately want to feel safer at work during a pandemic that has killed thousands of healthcare personnel.
Before President Joe Biden declared that all healthcare providers that participate in Medicare and Medicaid must vaccinate their 17 million employees against COVID-19, dozens of hospitals and health systems around the U.S. took the step on their own. The CEOs of three pioneer hospitals—Houston Methodist, the Medical University of South Carolina and Inova Health System—say their successes demonstrate the wisdom of requiring vaccines.
Healthcare worker shortages are real and hospitals shouldn't take lightly the possible loss of staff to vaccine mandates, said Dr. Stephen Jones, president and CEO of Inova Health System in Falls Church, Virginia. But the small numbers of employees who are giving up their jobs over vaccine mandates suggest the worry may be overblown.
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"It'll be disappointing losing a single person," Jones said. "We'll regret that they're not here. But we have a responsibility to prioritize the safety not only of our patients, but our own team members."
Hospital leaders face an admittedly sticky situation.
The COVID-19 vaccines are heavily politicized and resistance to immunization is higher in regions that voted for President Donald Trump over Biden in the 2020 presidential election. That influences healthcare workers as much as anyone else. Vaccine hesitancy also is higher among healthcare personnel with lower levels of education and professional training, as illustrated by a recent JAMA Internal Medicine study showing less than half of the lowest-trained nursing home employees were vaccinated. Healthcare professionals also are subjected to the same misinformation about the vaccines as the general public. And people of color have historical reasons to mistrust the medical establishment.
Healthcare workers are exhausted after more than a year of working through a pandemic that has claimed an estimated 675,000 American lives. Nurses, in particular, have cried out for help in the form of bigger staff, more personal protective equipment and greater respect from their managers—perennial complaints made more acute by the pandemic.
This is a workforce that's become skeptical of bosses—the very same people now pushing them to get vaccinated. The lackluster rollout of the federal vaccine mandate for nursing home employees illustrates the challenge.
The biggest fear is that mandating vaccinations will drive workers to take jobs at healthcare facilities without mandates, and hospitals can ill afford to lose employees at a time when shortages are already rampant and COVID-19 cases are rising. If the experience of those hospitals that were early to require inoculations is any guide, those concerns may well turn out to have been exaggerated.
Ultimately, hospital leaders must prioritize the rights and privileges of all parties involved: unvaccinated employees, vaccinated employees, patients and anyone else who enters a hospital. To do so, administrators reemphasized the fundamental notion that a hospital's first priority is its patients.
First in the nation
At Houston Methodist in Texas, the choice was clear, said Dr. Marc Boom, the seven-hospital not-for-profit system's president and CEO.
"We have a sacred obligation to care for patients and keep them safe. And frankly, we have an ethical responsibility as an employer to keep our employees safe," Boom said. "It was absolutely, unequivocally the right thing to do. I'm very proud of our almost 26,000 men and women for everything they've done for this pandemic, for stepping forward and doing the right thing."
Houston Methodist was the first U.S. hospital to announce a vaccine mandate when it notified employees of the coming policy in April, with a June 7 deadline. The results: a vaccinated workforce and only about 150 resignations, or 0.06% of its staff.
The health system weighed conflicting ethical obligations when making the decision to require employees to be vaccinated: bodily autonomy, informed consent, beneficence (do good) and non-maleficence (don't do bad), Boom said. In the end, the duty to patients and vaccinated workers trumped the rights of those who refused inoculations, he said.
A "small, vocal minority" protested the policy and they've garnered most of the attention, but Boom rejects their argument that bodily autonomy is the most important consideration.
"My autonomy to throw my fist ends when it hits your face," Boom said. "My autonomy as an individual is essentially overwritten by those other ethical principles if my autonomous decision to not get vaccinated as a healthcare worker results in the irreversible harm to somebody I'm caring for," he said.
"The majority of our team were thrilled to do this. They were already vaccinated. If they were vaccinated, they wanted everybody else vaccinated. They wanted to keep our patients safe," Boom said. "They were very proud of the fact that we were leaders in the country. Our tagline is 'Leading Medicine' and they were like, 'Yeah, we're living that,'" he said. Patients and community members have also expressed gratitude, he said.
A group of 178 Houston Methodist employees tried to sue to block the mandate after being suspended for not following it, but a federal judge dismissed the case in June.
What worries Boom now is the thought that those workers who left Houston Methodist rather than get vaccinated are spreading the coronavirus to patients elsewhere. "It chills me to know that some people leave and then just find other jobs—a home health agency, for instance. One of our individuals who left did that. I'm like, 'OK, great. They're walking into someone's home unprotected, and not protecting that—by definition—vulnerable person," he said.