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May 25, 2021

Should Covid-19 vaccines be mandatory for health care workers?

Daily Briefing

    Several major health systems—including University of Pennsylvania Health System (UPHS), RWJBarnabas Health, and Houston Methodist—are now saying they will require staff to get vaccinated against Covid-19, even as many other health systems are holding off on a mandate for now.

    Is America's coronavirus future 'good,' 'bad,' or 'ugly'? It's all three.


    Currently, all available vaccines in the United States have received only emergency use authorizations (EUAs) from FDA; none have been fully approved.

    However, in December 2020, the Equal Employment Opportunity Commission (EEOC) said employers that mandated staff get vaccinated against Covid-19 would not violate federal disability law or civil rights statutes on discrimination, as long as they provided employees excluded from the workplace because of their vaccination status accommodations such as telework or leave and permitted exemptions for those refusing the vaccine on religious grounds.

    And according to a poll conducted by the Washington Post and the Kaiser Family Foundation in April, nearly 60% of employed health care workers said they would support their organization mandating that all staff who work with patients get vaccinated.

    However, the poll found that, among the roughly 30% of health care workers who said they did not plan to get vaccinated or had not yet made a decision, more than 80% said they would oppose their employer mandating the vaccine—and nearly two-thirds said they would rather quit their job than receive the vaccination. Among all employed health care workers, the poll found about one in six would leave their job rather than be vaccinated.

    Why UPHS and RWJBarnabas mandated vaccination

    Amid this division, several health systems have opted to require staff to get vaccinated, Axios reports. Houston Methodist was among the first to do so in April, and on Thursday, two additional health systems made similar announcements.

    In one announcement, University of Pennsylvania Health System said staff must be vaccinated against Covid-19 no later than September 1, and all new employees as of July 1 must provide proof of vaccination two weeks before starting work. According to a press release, the health system has already made the vaccine available to all employees and clinical staff, with nearly 70% fully vaccinated as of May 19.

    "As an institution grounded in the science and art of health care, we believe it is imperative for Penn Medicine to take the lead in requiring employee vaccinations to protect our patients and staff and to set an example to the broader community as we work together to end the Covid-19 pandemic," UPHS CEO Kevin Mahoney said.

    Also on Thursday, RWJBarnabas Health said it would require supervisors and upper-level employees to be vaccinated by June 30, and that all of the system's 35,000 employees would eventually need to be vaccinated as well.

    "As health care workers and as team members committed to providing a culture of safety, we have an obligation to do all we can to protect our patients and the communities we serve," Barry Ostrowsky, president and CEO for RWJBarnabas Health, said. "As a health care leader in the state, we must set the precedent to always provide the safest environment and protect the residents of New Jersey."

    According to Oztrowsky, the health system's policy for those who do not comply with the requirement "is being finalized over the next several days."

    Why other health systems are holding off—for now

    However, other health care systems are holding off on such requirements, Becker's Hospital Review reports, at least until FDA issues full approval for the vaccines.

    "What we're hearing from many hospitals is that they will likely make determination of requirement of the Covid-19 vaccine for their own employees at the time the vaccines receive full approval from the FDA, which has not happened yet, but will likely happen soon," Nancy Foster, VP of quality and patient safety policy at the American Hospital Association, said. 

    For instance, Sentara Healthcare—a 12-hospital system with roughly 28,300 employees, about 66% of whom are at least partially vaccinated—said it is not yet going to mandate vaccination, in part because FDA has only authorized the vaccines. 

    "Do I believe there are any issues (with the vaccines)? No. But I don't have the data at hand to be able to say to you as a person—let alone an employee—that I am going to mandate that you have it," Jordan Asher, EVP and chief physician executive at Senatara, said. "I'm going to talk about the positives. But right now, I'm finding it difficult to create a mandate."

    Separately, Tracey Schiro—EVP and chief human resources officer at Ochsner Health, where roughly 55% of employees were vaccinated as of late April—said the system will not issue a vaccination mandate so long as the vaccines are only authorized, not fully approved, by FDA.

    "In speaking with our CMO about the mandatory status, we feel that until there is FDA final approval, then we will continue to evaluate thinking about making it mandatory," Schiro said. "Today, we do have the flu vaccine as a mandatory requirement unless someone has a medical or religious exemption, so once it's approved by FDA, I think we'll consider that and make our decision."

    In the meantime, Schiro said Ochsner was weighing whether, in lieu of a mandate, to offer employees financial incentives to get vaccinated. "We're having executive discussions around an incentive based on what we've seen from peers across the country," she said. "Some of our thinking is it may be something we want to put there for our employees to thank them for getting the vaccine and continuing to encourage people to get the vaccine" (Gooch, Becker's Hospital Review, 5/19; Fernandez, Axios, 5/21; Penn Medicine News, 5/20; RWJBarnabas Health press release, 5/20; Brubaker, The Philadelphia Inquirer, 5/20; Washburn/Fallon, NorthJersey.com, 5/20).

    Is America's coronavirus future 'good,' 'bad,' or 'ugly'? It's all three.

    looking aheadSince February, Advisory Board's Brandi Greenberg has been tracking three ways the U.S. coronavirus epidemic could end: the "good," the "bad," and the "ugly." But new data, she says, has forced her to revise her expectations about what Covid-19's future will look like—for America and for the world. 

    Read the latest take

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