More and more hospitals and major health systems are requiring employees to get the Covid-19 vaccine, citing rising caseloads fueled by the Delta variant and stubbornly low vaccination rates in their communities and even within their work force.
Many hospitals say their efforts to immunize their employees have stalled, in much the same way the nation’s overall vaccination rates are stuck under 60 percent, behind many European countries and Canada. While more than 96 percent of doctors say they are fully vaccinated, according to the American Medical Association, health care workers, particularly in rural areas, have proven more resistant even though thousands of workers have died from the virus and countless more became sick.
One recent estimate indicated that one in four hospital workers were not vaccinated by the end of May, with some facilities reporting that fewer than half of their employees had gotten the shots.
Some hospitals, ranging from academic medical centers like NewYork-Presbyterian and Yale New Haven to large chains like Trinity Health, are going ahead with a mandate because they recognize that the only way to stop the virus is to vaccinate as many people as possible, as quickly as possible. A large Arizona-based chain, Banner Health, announced Tuesday that it would impose a mandate, and New York City said it would require all health care workers at city-run hospitals or clinics to be vaccinated or undergo weekly testing.
Watching cases rise prompted Trinity Health, a Catholic system with hospitals in 22 states, to become one of the first major groups to decide earlier this month that it would mandate inoculations. “We were convinced that the vaccine can save lives,” said Dr. Daniel Roth, Trinity’s chief clinical officer. “These are preventable deaths.”
At UF Health Jacksonville, in Florida, the number of Covid patients being treated has surged to levels not seen since January, and only half of its health care workers are vaccinated, said Chad Neilsen, the director of infection prevention. Seventy-five employees are out sick with the virus, the vast majority of whom are unvaccinated, while more are waiting for test results. “We are absolutely struggling for staffing right now,” he said.
“It’s like déjà vu,” said Mr. Neilsen, who described growing frustration with colleagues refusing to get the shots. “We have a reason to believe this could be over if people got vaccinated.”
Despite dozens of virtual town halls, question-and-answer sessions and educational videos, many employees are wary. “We still stagnated,” Mr. Neilsen said.
Some employees want more data, while others say the process has been too rushed. Many of the same conspiracy theories and misinformation — that the vaccines will make women infertile or contain microchips — hold sway among staff members. “Our health care workers are a reflection of the general population,” he said.
Hospital leaders and others plan to meet with state officials in the coming weeks about the possibility of imposing a mandate, he said.
Unvaccinated workers also continue to care for even the sickest patients, raising concerns that they will spread the infection, especially now that the highly contagious Delta variant comprises more than 80 percent of the nation’s cases.
“Nowhere is this more important than in hospitals, where health care personnel — who have been heroic during this pandemic — are caring for patients with a wide variety of health challenges under the assumption that the health care professionals treating them are not at risk of acquiring or transmitting Covid-19,” Dr. David J. Skorton, the chief executive of the Association of American Medical Colleges, which represents teaching hospitals, said in a statement last Friday calling for a mandate.
With formal approval of the vaccines by the Food and Drug Administration potentially months away, hospitals find themselves at the center of the national debate over whether to impose mandates. While the vaccines are being offered under emergency use authorization, supporters argue there is ample evidence that the ones available in the United States are both safe and effective.
In states like Missouri, which has reported a sharp increase in cases, there is newfound urgency. “We felt we could not wait,” said Dr. Shephali Wulff, the director of infectious diseases for SSM Health, a Catholic hospital system whose headquarters are in St. Louis. SSM, where about two-thirds of employees are now vaccinated, is requiring everyone to get their first dose by Sept. 1.
SSM’s decision was also motivated by concern that Covid infections could spike this fall when there could also be a surge in other respiratory infections. “We need a healthy work force going into the flu season,” Dr. Wulff said. “We do not have the time to wait for approval.”
But some systems are already worried about staffing shortages caused by departures during the pandemic, with many employees quitting because of the stress and burnout experienced by caring for Covid patients. Hospitals are hesitant to risk losing more workers if they force the issue.
“They are afraid it could be a tipping point,” said Ann Marie Pettis, the president of the Association for Professionals in Infection Control and Epidemiology, one of the professional organizations that is urging hospitals to require the vaccine.
At Mosaic Life Care, a small Missouri hospital group, executives are reluctant to adopt a mandate if other hospitals do not. “We have the potential to lose some caregivers to other systems,” said Joey Austin, a spokeswoman for Mosaic, which has vaccinated about 62 percent of its staff.
Many hospitals already require their employees to get a flu shot, a mandate that has been in place for over a decade. While that was also met by resistance from employees skeptical of the vaccines’ safety, it is now largely accepted. Individuals can seek a medical or religious exemption, typically representing a small sliver of the work force, which hospitals say would also apply to the Covid vaccines.
Mandates “establish a social norm and say it’s an institutional priority,” said Saad B. Omer, the director of the Yale Institute for Global Health, who emphasized that hospitals need to strongly encourage workers to voluntarily get the vaccines to be successful.
Unions like the National Nurses United and 1199 S.E.I.U. say they want members to be vaccinated but oppose making it a condition of employment. At the first hospital to impose a mandate, Houston Methodist, a group of employees sued to challenge the requirement but the lawsuit was recently dismissed. About 150 employees ultimately resigned or were fired for refusing to meet the deadline for vaccination out of a total work force of some 26,000 people.
Hospitals say they are working hard to dispel much of the pervasive misinformation around the vaccines, even among physicians and nurses.
“I have to remind them that reputable scientists do not publish their findings on YouTube,” Dr. Wullf said. In addition to presenting hard data about the vaccine, she and her colleagues at SSM are also sharing their personal experiences, like getting vaccinated while trying to get pregnant. “What I’m finding is people are moved by stories and anecdotes,” she said.
“Generally it’s a lot of listening and homing in on what is driving their fear,” Dr. Wulff said.
Some high-profile systems like Intermountain Healthcare and the Cleveland Clinic are waiting. The clinic, which has a sprawling network of 18 hospitals in the United States, said existing policies, like masking and closely tracking infections, protect patients and workers.
“We know if we ensure these safety precautions are in place we know we can continue to keep our patients and caregivers safe,” said K. Kelly Hancock, the Cleveland Clinic’s chief caregiver officer.
About three-quarters of employees are now vaccinated, and efforts are continuing “full force,” she said.
At Intermountain Healthcare, based in Utah, “a good majority” of employees are vaccinated, said Dr. Kristin Dascomb, medical director for infection prevention and control and employee health.
If more safety data is compelling and the F.D.A. approves the vaccines, Intermountain may require immunization along with other hospitals in the state. “We are starting the conversation now in Utah,” she said.
The lack of full F.D.A. approval has also influenced other hospitals. Mass General Brigham, which has vaccinated more than 85 percent of its work force, said it would adopt the requirement as soon as the vaccines were approved.
Some hospitals argue a mandate is not necessary. “In my opinion, there isn’t one right answer,” said Suresh Gunasekaran, the chief executive of the University of Iowa Hospitals & Clinics. About 90 percent of its workers are now vaccinated, he said, adding that he was confident that virtually everyone would be immunized by the end of the year.
The system has been “successful in chipping away” at vaccine hesitancy, Mr. Gunasekaran said, in part because Iowa was involved in the clinical trials for the Pfizer-BioNTech vaccine.
Northwell Health, the large New York hospital group, does not require workers to be immunized against the flu but about 90 percent of its work force is vaccinated against it, said Maxine Carrington, Northwell’s chief human resources officer. It is taking a similar approach to Covid.
“We want people to be believers,” Ms. Carrington said, so they are better able to persuade the community at large to get vaccinated. She described the system as “pounding the pavement on education, education, education.” About 76 percent of its work force is currently vaccinated against Covid. Northwell will revisit the idea of a mandate after F.D.A. approves the vaccines, she said.
Yale New Haven Health is now requiring employees to get vaccinated, as have the other hospitals in Connecticut.
“From the very beginning, we messaged that it isn’t mandatory — yet. We emphasized the yet,” said Dr. Thomas Balcezak, the chief clinical officer for Yale.
“Health care has to lead,” he said.