safety and efficacy . Effective campaigns should also aim to carefully explain a vaccine ’ s level of effectiveness , the time needed for protection ( with multiple doses , if required ) and the importance of population-wide coverage to achieve community immunity . Instilling public confidence in regulatory agency reviews of vaccine safety and effectiveness will be important .”
• Currently , with numerous vaccine mandates being enforced as of late September the vaccine preferences of healthcare personnel have settled into two opposites — those either already vaccinated or those explicitly refusing to get the vaccine .
Mandatory Vaccination and the Workforce Conundrum
Since late spring and early summer 2021 , hospitals and healthcare systems have adopted policies making COVID-19 vaccination mandatory , or as some medical societies are calling it , a condition of employment ( CoE ). A circulating statistic at the time indicating that just 1 in 4 healthcare providers were vaccinated against SARS-CoV-2 may have served partly as impetus for action , as health officials emphasized the infectiousness of the Delta variant .
Currently , with numerous vaccine mandates being enforced as of late September the vaccine preferences of healthcare personnel have settled into two opposites — those either already vaccinated or those explicitly refusing to get the vaccine . The conundrum is summed up by Koons and Court ( 2021 ): “ Mandate the vaccine , and some of your nurses will quit . Don ’ t mandate the vaccine , and some of your nurses will get COVID — rendering them unable to work , or even landing them in the very intensive care unit where they normally work . For a hospital administrator who ’ s been dealing with nursing shortages escalating throughout the pandemic , this is the dilemma .”
Koons and Court ( 2021 ) quoted Alan Levine , chief executive officer of Ballad Health , which has 21 hospitals and other centers serving patients in Kentucky , North Carolina , Tennessee , and Virginia , as commenting , “ It ’ s a cynical question , but what gets us to losing the higher ( number ) of staff ?” Levine is reported as explaining that he decided not to require vaccinations for his system ’ s healthcare personnel after modeling suggested he could see 15 percent of nurses – as many as 900 – quit if he did . As Koons and Court ( 2021 ) explain , “ That ’ s more than he anticipates losing to COVID-19 quarantines and illness , even with the most recent surge filling up the network ’ s ICUs and 130 staffers quarantining on a single mid-August day . At Ballad , 97 percent of doctors are vaccinated . Among frontline nurses , he estimates vaccination rates hover around 50 percent .”
Koons and Court ( 2021 ) observe , “ It ’ s hard to comprehend how nurses , who see firsthand evidence of how COVID can kill people , could oppose getting a vaccine that ’ s been shown in numerous studies to provide extraordinary protection against severe illness and death . But it ’ s a problem that hospital administrators all over the country find themselves facing . In the most recent survey by the American Nurses Association ( ANA ), fielded as part of a broader coalition of nursing groups intended to combat vaccine hesitancy in its ranks , almost 1 in 8 hadn ’ t gotten the vaccine or didn ’ t plan to , despite having had access to the shots for almost nine months .”
Gur-Arie , et al . ( 2021 ) describe the tension between healthcare systems and their employees who have survived a pandemic together but are now splintering over duty to care that involves vaccine mandates : “ Critical analysis of the institutional responsibility to ‘ do no harm ’ has been overshadowed by the hero narrative associated with healthcare personnel ( HCP )’ s bravery and dedication to work throughout the COVID-19 pandemic . However , the appropriateness of the ‘ hero narrative ’ weakens when institutions and healthcare systems fail to protect HCP ’ s health and wellbeing , especially when effective interventions are available but not implemented . This has arguably undermined trust between HCP and their institutions and perhaps also trust in the safety of COVID-19 vaccines . Institutions and healthcare systems which consider adopting a COVID-19 vaccine mandate among HCP should not ignore this history and context , in which HCP ’ s occupational conditions have consistently put them at higher risk of contracting and spreading COVID-19 . Consequently , the failed institutional responsibility to assist HCP in the fulfilment of their duties to ‘ do no harm ’ weakens appeals to such duties in the justification of vaccine mandates .”
Gur-Arie , et al . ( 2021 ) seem more empathetic to healthcare workers than many public health experts have been lately , observing , “ The notion that HCP consent to caring for patients , even if this puts HCP at significant risks of infection and even death , is expressed through implicit social contracts ( HCP receive special privileges in society , and are expected to provide healthcare , when necessary , in return ) and in professional codes of conduct . Calls for COVID-19 vaccine mandates for HCP made based on HCP ’ s duty to care draw on the utilitarian notion that requiring vaccination would allow maximum benefit to the public by keeping HCP healthy and working during the pandemic at the expense of HCP autonomy . However , the utilitarian argument in this context is arguably flawed because it focuses primarily on the social value of HCP ’ s labor . There are non-coercive interventions that can effectively combat COVID-19 , such as widespread voluntary vaccination and non-pharmaceutical interventions in the general population . Such alternative interventions may achieve greater overall benefits including , indirectly , a reduction of healthcare-acquired infections , without specifically mandating HCP to get vaccinated against COVID-19 . In this case , unless supply of COVID-19 vaccines is highly limited and there is good reason to think that enforced HCP vaccination produces maximum overall benefit , an HCP mandate could be even less justifiable .”
The American Hospital Association estimated that as of mid-August , 35 percent of hospitals nationwide have mandated that personnel get vaccinated against SARS-CoV-2 . The term “ mandatory ,” however , can be contentious among experts .
“ We don ’ t ever use the M word ,” confirms David Weber , MD , MPH , medical director of hospital epidemiology and associate chief medical officer at University of North Carolina Health Care . “ We don ’ t ever call anything mandatory . We talk about it as vaccine uptake being a condition of employment , because after all , someone can always choose not to work for us and they don ’ t have to take the vaccine ; so , we don ’ t actually make people get the vaccine . I understand that many people may conceive of it as mandatory , particularly if everybody requires it , but that ’ s our preferred term .”
As we will see in another section , the consensus statement , Multisociety Statement on COVID-19 Vaccination as a Condition of Employment for Healthcare Personnel , authored by Weber