Hospital Vaccine Mandates Suggest Success in Boosting U.S. Shots

(Bloomberg) -- Covid vaccines soon will be required for all the roughly 6,000 staff members of New England’s biggest assisted living network, Benchmark Senior Living.

“How could we look people in the eye who were considering moving Mom or Dad into a community and say that we hadn’t taken this step?” said Benchmark Chief Executive Officer Tom Grape.

The proportion of vaccinated staffers has jumped to 73% from 56% since the network announced its mandate in May, and it aims to have everyone inoculated by the end of the month, with exemptions for medical or religious reasons. Only a handful of workers have quit rather than get the shot, Grape said.

Vaccine mandates remain a contentious issue across the U.S., even as they’ve become commonplace at universities. Now they’re starting to spread among major medical systems such as Trinity Health, which said on Thursday it will require its more than 117,000 employees in 22 states to get Covid vaccinations. Most must show proof of vaccination by Sept. 21; those who fail to do so and do not meet criteria for exemption will be terminated.

The experience of Benchmark and some hospital systems suggests the mandates can boost vaccination rates without major staffing losses -- allaying employer fears that they would worsen an already-acute labor shortage.

“This is gaining momentum in the country,” said Kevin Sowers, president of the Johns Hopkins Health System, which announced its plans for a vaccine mandate last month. He said most academic medical centers “are considering how they’re going to roll it out with their workforce.”

Former New York City associate health commissioner Mark Barnes predicts that in other sectors, from financial services to light industry, “we’re going to see more vaccine mandates by large organizations of all kinds as the months go by.”

They’ll be driven by the desire for workplace safety among co-workers, clients and customers, particularly as the highly contagious delta variant spreads and colder weather looms, said Barnes, now a partner at the Boston law firm Ropes & Gray.

The mandates contrast with the Biden administration’s policy of avoiding coercion when it comes to Covid vaccines, relying instead on persuasion and even sometimes pleading. “Please, please get vaccinated,” the president said this week.

As hospitals and other health-care venues gauge their staff vaccination rates, many are finding that persuasion hasn’t been enough to reach the near-universal levels needed to protect people who are medically vulnerable.

When the University of Pennsylvania Health System announced its mandate in May, just three-quarters of its employees were vaccinated, or about 33,000. Another 11,000 were not, despite extensive access and education efforts.

It’s now requiring everyone to get vaccinated by Sept. 1 -- and then will discuss the consequences if they’re not, said P.J. Brennan, its chief medical officer. “It’s naive to think at this point that more education or information will change people’s minds,” he said.

In Massachusetts, the two biggest hospital systems -- Mass General Brigham and Beth Israel Lahey Health -- both announced on June 24 that once Covid vaccines gain full federal approval (beyond the current emergency-use status), they will be required for all staffers, a total of about 115,000. The hospitals had reached about an 85% vaccination rate without the mandate, their leaders said.

“Is 85% good? Absolutely,” Mass General Brigham CEO Anne Klibanski said in an interview. “Is it good enough? No.”

A national analysis by the medical-news site Medscape found that as of late May, about three-quarters of hospital workers who have direct contact with patients had been vaccinated. Some hospital rates are as low as 30%, it found.

The American Hospital Association isn’t tracking how many among the roughly 6,000 hospitals nationwide are mandating Covid vaccines, said Nancy Foster, vice president for quality and patient safety policy. But she expects more mandates in the weeks to come.

“Certainly, when Hopkins and Penn and Mass General Brigham and other leading institutions decide to do this, it signals the rest of the field,” she said.

Vaccine mandates appear to be taking off among senior residences as well, said Beth Mace, chief economist at the nonprofit National Investment Center for Seniors Housing and Care. It estimates that about two-thirds of residence staff have been vaccinated.

Senior housing occupancy dropped to record lows during the pandemic, and vaccine mandates “are likely to be a competitive advantage,” she said. Families with fresh memories of the pandemic’s fear and separation are likely to feel, “Let’s not go back!”

Several major senior housing chains have already brought in mandates -- and they’re spreading to nursing homes as well, despite concerns they could add to staffing challenges.

Going First

Among the hospitals imposing mandates, the Houston Methodist system went first, in April, and offers an early glimpse of results.

Of about 26,000 employees, a spokeswoman said, 153 resigned or were terminated. The rest went from an 85% vaccination rate when the mandate was announced to 100%. Some 600 staffers were exempted for religious or medical reasons, or got a deferral for pregnancy.

More than 100 employees who opposed the mandate sued, accusing Houston Methodist of making them get an experimental vaccine. Though the hospital system won an initial court victory, the workers are appealing and their lawyer predicts legal battles around the country.

Barnes from Ropes & Gray counters that as long as the mandates allow religious and medical opt-outs, legal challenges “would be misguided folly, because they have little chance of success.”

It may depend where and when, however. Multiple states have passed or are considering laws banning Covid vaccine mandates, at least as long as the vaccines have only emergency use approval. Full federal approval is expected soon.

“People have not rushed to the front of the line” to impose mandates, said Brennan from Penn. “I think they’re waiting it out” —- waiting for the full federal approval — “and I think that will take a lot of the hesitation off the table.”

Though Mass General Brigham is among those delaying its mandate until a vaccine gets full approval, “we do not regard it as experimental at all,” CEO Klibanski said. Overall, she said, the staff response to the mandate is highly positive, with some saying “it’s about time,” and a “very, very tiny number of employees” among the system’s 80,000 saying, “‘We choose not to work at a place where there’s mandatory vaccination.’ And we all respect that.”

No lawsuits have been brought, Klibanski said, but “it is possible they will occur. And I would just say that the basic principle is: What is the right thing to do to protect patients and to protect employees and each other?”

At the Benchmark Senior Living residence in the Boston suburb of Woburn — one of 63 Benchmark sites across seven states – resident support for staff vaccination runs strong.

“I couldn’t imagine not getting vaccinated, for anyone,” 90-year-old Joanne Morgan said. If a staffer refused to get vaccinated, said retired nurse Mary E. MacDonald, she would be inclined to say “There’s the door.”

Yet, this winter when vaccines became available, some staffers did hesitate and decline, said Sabrina Krafchuk, director of mind and memory care, who manages 35 workers.

Fear held them back, said lead resident care associate Janviere Dukuzemariya —- fear stemming from anti-vaccine information on social media, YouTube, and from family and friends.

She ultimately got vaccinated in May after speaking to her doctor. Some of her co-workers initially said “‘If it will be mandatory, we’ll quit,’” she said, but now, “everybody understands.”

Time helped. Staffers saw first-hand in recent months that vaccinated residents who tested positive for Covid got only mild symptoms, Krafchuk said. That helped bring them to the point of, “Yes, I want to get vaccinated now,” she said.

Certified nurses aide Deborah Kissa grappled with fear as well, and with confusion from conflicting opinions, to the point that she did not get fully vaccinated until June 25. Conversations with managers like Krafchuk helped, she said. So did seeing them get vaccinated first.

Still, if the mandate hadn’t required her to get the vaccine, she said, “it would have taken me some good time to take it.”

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