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Mrequests are disabled. Theaters and dining rooms are back. Life seems to be returning to its normal course. And yet, the highly transmissible and possibly more deadly Delta variant is spreading rapidly, accounting for half of new cases of Covid-19 in the United States and causing outbreaks in nearly half of all states. New studies demonstrate the efficacy of vaccines against the immune evasion properties of this new variant, which pose a serious threat to partially vaccinated or unvaccinated individuals.
Education and factual information did not even get us halfway to a fully immunized population. States have tried million dollar lotteries and other incentives. Yet only 1% of the population is vaccinated every week. We have to move on: employer mandates.
Universities require students to be vaccinated and many, including our own University in Pennsylvania, also require staff and faculty to be vaccinated. United and Delta Air Lines, which carry hundreds of passengers nearby, require vaccines for all new employees. Even employees of the Broadway hit “Hamilton” will need to be vaccinated to ensure the safety of the actors and the audience.
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One industry that has been eerily silent about warrants is the health care industry, including hospitals, home care agencies, long-term care facilities, and the like. Why are the 17 million healthcare workers in hospitals, nursing homes, skilled nursing facilities, home care agencies, and ambulatory care sites such as federally licensed health clinics, pharmacies, doctors’ offices, physiotherapy offices, etc. to get vaccinated against Covid-19?
Since the beginning of June, there continues to be around 150 deaths per week among residents of nursing homes due to Covid-19. Almost 80% of nursing home residents have already been vaccinated, well above the threshold of around 70% cited by most experts for obtaining herd immunity. The problem appears to be the low vaccination rate among the staff.
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Nationally, only 55% of these staff have received the Covid-19 vaccine, and great variability exists from one nursing home to another. In New York State, 85% of nursing home residents have been vaccinated, while in many facilities less than 40% of staff have been vaccinated, including one in Oneida County where only 16% staff have been vaccinated.
While every death from Covid-19 is a tragedy, those in nursing homes are particularly so because most of them are preventable. Many have been attributed to unvaccinated workers who then infect other workers and vulnerable residents who cannot develop strong immune reactions to the vaccine.
The low immunization rate among healthcare workers is not limited to long-term care facilities. A survey of nine hospital networks found rates of fully immunized workers to be as low as 53%. Worse yet, as we increasingly rely on out-of-hospital care, it turns out that only 26% of home health workers had been vaccinated as of March. A survey released in April found that at least 30% of healthcare workers are “hesitant about vaccination” with 18% of frontline workers strongly opposed to vaccination.
It is one thing for a trader not to get vaccinated. It is unethical and appalling for a healthcare worker.
No vulnerable and immunocompromised patient – the elderly, cancer and transplant patients, people living with HIV / AIDS and others – trying to conquer their disease should have to fear that those who care for them may be asymptomatic carriers of Covid-19.
According to the American Association of Medical Colleges, just three weeks ago, only half a dozen healthcare systems, including the University of Pennsylvania healthcare system, where we work, as well as the Methodist Hospital, NewYork-Presbyterian, Johns Hopkins Medicine, and nearly all hospitals in Washington, DC, had required all staff to be vaccinated against Covid-19. As more health systems have started to introduce vaccine requirements in recent weeks, it may take months for a significant number of health care organizations to follow suit, over the course of time. from which new variations and new challenges could emerge.
During this time, the warrants have been very effective. Nearly 250 long-term care facilities operated by three companies have introduced warrants and have thus achieved approximately 95% vaccination rates among staff.
Making vaccination compulsory is not only the right thing to do, it is also the ethical thing to do. All healthcare workers agree that their highest duty is to promote the best interests of their patients. According to the terms of the Hippocratic Oath, the doctors pledged that “In all the houses I go to, I will enter them for the sake of the sick …” (There were no hospitals there. hippocratic days, only home care.) Nurses are committed to “devoting myself to the well-being of those in my care.” And so on for all healthcare workers, from phlebotomists to pharmacists: they are all committed to using their skills to “ensure optimal results for my patients”.
An immunization mandate simply implements the healthcare workers’ promise to patients and the community.
The healthcare industry’s commitment to these words faces a test on which the lives of patients depend. Healthcare organizations and leaders, from the American Medical Association to the American College of Physicians, from the American Nurses Association, from the American Hospital Association and the Association of American Medical Colleges to CEOs of institutions in prominent places such as Stanford University, Mayo Clinic, Massachusetts General Hospital, and intermediate points should unequivocally proclaim that every healthcare worker in the country has a duty to be vaccinated against Covid-19 and that institutions health and other employers should mandate vaccination.
Why has healthcare taken so long to carry out vaccinations against Covid-19? Some say the industry is waiting for the vaccine to be formally and fully approved by the FDA. Others worry about the legality of mandates; that workers will quit, making it difficult to fill jobs; or weighing in on a public controversy.
None of these excuses are valid. Leadership requires taking the moral path even when it is not popular. And medical ethics – backed by recent regulatory and judicial rulings – support the tenure decision as the best course for the nation’s health.
The vaccines currently available in the United States are as safe and effective as any vaccine available – and are much safer than getting Covid-19. The FDA will likely grant full approval for the Pfizer and Moderna vaccines within a month or two. The guidelines of the United States Equal Employment Opportunity Commission have made it clear that employers have the legal authority to require a vaccine and that they can do so even if the vaccine is only approved for use. emergency use. Last month, a Texas federal judge dismissed a case by 117 Houston Methodist staff over the hospital system’s vaccination mandate, effectively confirming that those mandates were legal. A total of 25,000 employees complied with the mandate.
The vast majority of workers are unlikely to resign in response to a mandate. Few have made it to Houston Methodist. And Atria Senior Living was one of the first senior care companies to mandate vaccines when it announced in January that all 10,000 employees must be fully immunized by May 1. The company reported that due to its efforts combining tenure with education and support, employees embraced the vaccine and the company achieved a 98% vaccination rate. Other senior housing companies – within an industry suffering from chronic staff shortages – have followed in recent months with equally successful results.
Throughout the Covid-19 pandemic, healthcare workers have gone beyond their professional oaths, sometimes facing shortages of personal protective equipment and facing personal risks in treating patients. Now, a year later, unvaccinated health workers are putting patients at risk and prolonging the very crisis they fought on the front lines.
It is time for hospital system leaders and communities of physicians, nurses and long-term care workers to step up their efforts and meet their obligations to put patients and community health first.
Ezekiel J. Emanuel is a physician, vice president of global initiatives, and co-director of the Healthcare Transformation Institute at the University of Pennsylvania. Patricia Hong and Matthew Guido are researchers in the Department of Medical Ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania.
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