medical center in which a comprehensive mandatory immunization initiative was implemented in two phases . Key facets of the initiative included a formalized exemption review process , incorporation into institutional quality goals , data feedback , and accountability to support compliance . Both immunization and overall compliance rates with targeted immunizations increased significantly in the years after the implementation period . The influenza immunization rate increased from 80 percent the year prior to the initiative to more than 97 percent for the three subsequent influenza seasons . Mumps , measles and varicella vaccination compliance increased from 94 percent to more than 99 percent in three years , while rubella vaccination compliance increased from 93 percent to 99.5 percent , and hepatitis B vaccination compliance from 95 percent to 99 percent . TB testing compliance , which was not included in the mandatory program , increased from 76 percent to 92 percent over the same period .
A year later , writing in JAMA , Talbot ( 2021 ) observes , “ The recognition of HCP vaccination as an essential component of patient and HCP safety programs emerged in the mid-2000s with a focus on influenza vaccination . Prior to the 2009-2010 influenza season , despite increased awareness of the importance of HCP influenza vaccination and large-scale , resource-intensive voluntary vaccination campaigns , vaccination rates remained very low . While HCP influenza vaccination was first recommended by the Advisory Committee on Immunization Practices in 1978 , innovative , patient safety-focused programs at hospitals like Virginia Mason Medical Center paved the way for stronger expectations surrounding HCP vaccination . The success at these institutions , professional society endorsements of influenza vaccination as a condition of employment policies , and the addition of HCP influenza vaccination as a publicly reported quality measure were associated with increases in vaccination rates from around 45 percent to nearly 80 percent , with higher rates among acute-care facilities , physicians , and nursing personnel . During the 2019-2020 season , the percentage of hospital-based HCP who reported working under an employer influenza vaccination requirement reached 72.1 percent Very few HCP have had their employment terminated due to policy refusal , particularly considering the thousands encompassed by these policies .”
Talbot ( 2021 ) continues , “ With the advent of highly effective SARS-CoV-2 vaccines , the HCP vaccination discussion has turned their direction . Healthcare systems should learn from the decisions on influenza vaccination requirements for HCP in drafting SARS- CoV-2 vaccination policies for HCP .”
Writing three months before the national vaccine mandate , Talbot ( 2021 ) said moving from a voluntary program to a condition of employment policy for a vaccine-preventable infection begs several key questions :
• Do HCP become infected with the pathogen ? Are HCP at an increased risk for infection due to their occupation ?
• Can HCP have asymptomatic infection with the pathogen ? Do these HCP still spread the pathogen to others ?
• Is there a vaccine that is safe and effective in preventing infection ?
• Does vaccination affect pathogen transmission ?
• Do HCP have frequent contact with individuals who cannot mount a robust immune response to vaccination ( and , therefore , rely on others to reduce exposure )?
• Do voluntary HCP vaccination programs attain high enough coverage to prevent pathogen transmission ?
Talbot ( 2021 ) observes that answers to these questions “ drove the implementation of influenza vaccination as a condition of employment policies for HCP . Examining them through the lens of COVID-19 finds that the arguments for SARS-CoV-2 vaccination as a condition of HCP employment are even stronger .”
Talbot ( 2021 ) emphasizes additional considerations that healthcare facility leadership should evaluate when grappling with CoE policies :
• Whether any vaccine approved under an EUA by the FDA can be mandated is unclear : “ Legal scholars have cited the language in the EUA portion of the Federal Food , Drug , and Cosmetic Act around an option to ‘ refuse ’ a product approved under an EUA but noted mention of ‘ consequences ’ of such refusal . Leaders of healthcare facilities have expressed a desire to place a hold on any COVID-19 vaccination requirement for HCP while the vaccines are under EUA approval . With the impending full licensure of the mRNA COVID-19 vaccines , however , this concern will soon become moot .”
• Any program should make allowances for individuals who cannot be vaccinated : “ While the currently approved vaccines have very few medical contraindications , some HCP may develop allergic reactions to the first dose of an mRNA vaccine and may not be able to receive the second dose necessary for full immunity . Such HCP could opt for other types of COVID-19 vaccines so even in those instances , HCP unable to take any COVID-19 vaccine due to a medical contraindication should be rare . Exemptions to vaccination on religious or personal beliefs are more complicated . With the example of influenza , most organized religions endorse receipt of vaccines , and allowance of such exemptions can increase the risk of SARS-CoV-2 introduction into the healthcare setting . Nonetheless , providing a venue for such concerns to be thoughtfully reviewed can be important for acceptance of these policies .”
• Alternative approaches for HCP who are unable or refuse to be vaccinated should be included : “ These may be a requirement for use of infection prevention measures to protect patients and other HCP ( masking when working in the healthcare facility ) or added assessments of asymptomatic infection among unvaccinated HCP ( periodic testing for asymptomatic infection ) when SARS-CoV-2 is circulating . Unlike influenza , however , COVID-19 has yet to exhibit seasonal trends that would allow clear delineation when such interventions for unvaccinated HCP should be in place .”
Support for Mandatory Vaccination Galvanizes
In mid-July , several national organizations in epidemiology and infection prevention announced a consensus statement supporting COVID-19 vaccination for healthcare personnel , even going so far as to say that it should be a condition of employment . The statement explains what to consider in developing a policy of mandatory COVID-19 vaccination , including a thorough overview of current vaccines ’ safety and efficacy , legal considerations , ways to engage stakeholders and improve vaccination rates before implementing a policy of vaccination as a condition of employment , and advantages to having a fully vaccinated workforce .
“ The COVID-19 vaccines in use in the U . S . have been shown to be safe and effective ,” said UNC ’ s David Weber , a member of the Society for Healthcare Epidemiology of America ( SHEA ) board of trustees and lead author of the statement . “ By requiring
www . healthcarehygienemagazine . com • october 2021
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