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Some health care workers may quit rather than get vaccinated, experts say

People gather in front of Bay Area Hospital protesting the mandatory Covid vaccine for healthcare workers, Aug. 25, 2021. (SBG)
People gather in front of Bay Area Hospital protesting the mandatory Covid vaccine for healthcare workers, Aug. 25, 2021. (SBG)
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Most health care workers in the United States will need to be vaccinated against COVID-19 under a new White House directive, but some fear the ultimatum will drive those who have resisted immunization out of their jobs at a critical moment.

As infections rise and many hospitals report being overwhelmed with COVID-19 patients, President Joe Biden unveiled a six-point strategy to combat the pandemic Thursday. That plan includes extending a vaccine mandate to most health care facilities that receive Medicare or Medicaid reimbursement, covering 17 million workers nationwide.

“If you’re seeking care at a health facility, you should be able to know that the people treating you are vaccinated,” Biden said. “Simple. Straightforward. Period.”

Implementing that order might not be simple or straightforward, though. According to the National Academy for State Health Policy, 22 states already had mandates for health care workers in place, but states and facilities that instituted requirements have often been met with lawsuits, protests, and resignations.

Rick Pollack, president and CEO of the American Hospital Association, said his organization supports vaccine mandates for health care workers. Still, he urged the Biden administration to work with hospitals to develop “aggressive and creative strategies” to ensure they have sufficient staffing.

“As a practical matter, this policy may result in exacerbating the severe workforce shortage problems that currently exist,” Pollack said in a statement.

The surge of the delta variant has left many facilities struggling to fill shifts and care for patients, and concerns were already growing about frontline workers burning out. Earlier this month, the American Nurses Association urged the Department of Health and Human Services to declare the shortage of hospital staff a “national crisis.”

One hospital CEO told Bloomberg internal models estimated up to 15% of his nurses would quit if vaccines were mandated. Administrators determined that was more than they stood to lose to infections and quarantines, so they opted against the requirement, but Biden’s latest action might leave them with little choice.

A recent American Nurses Association survey found nearly 12% of nurses do not plan to get vaccinated, with most citing concerns about safety or doubts that immunization is necessary. More than two-thirds of respondents supported vaccine mandates for at least hospital workers who deal with the public.

Among all health care workers, a Washington Post/Kaiser Family Foundation survey earlier this year found almost 20% did not intend to get vaccinated, and one-in-six would rather quit than take a shot if mandated. Those who were not directly involved with treating and diagnosing patients in hospitals were much more likely to be hesitant than frontline workers.

A more recent study by the COVID States Project showed 15% of health care workers remained resistant to vaccination as of late July. Opposition to immunization was highest among those who were Black, had lower incomes, or were less educated.

Vaccine hesitancy among health care workers appears to reflect trends among the general public. Many have fears about side effects or efficacy – despite evidence COVID-19 vaccines are safe and effective – and much of the reticence is driven by misinformation.

“The same concerns you’ll find in the general population about lack of data showing the efficacy of the vaccine and concerns about long-term side effects can still be pervasive within parts of the medical community,” said Amber Reinhart, an expert on health communication at the University of Missouri-St. Louis.

Although health care workers have witnessed firsthand the damage the virus can inflict, many who are young and relatively healthy might doubt they would personally suffer adverse outcomes if infected. According to Jennifer Reich, a sociologist at the University of Colorado Denver and author of “Calling the Shots: Why Parents Reject Vaccines,” they are weighing that possibility against the perceived risks from a new vaccine.

“The thing with health care workers is, their risks and obligations are a little bit different,” Reich said, noting unvaccinated staff could place patients in danger.

Experts say mandates are likely to convince some workers to roll up their sleeves for shots, but others will walk away if they have other career options or feel deeply that this infringes on their liberty. That could lead to shortages of support staff in some facilities.

“I think a mandate will force people to examine the choices they have available to them and how strongly they feel about their hesitancy,” Reinhart said. “If someone has been working in health care for most of their life, needs their job to support themselves or their family, and has mild hesitancy, they are more likely to get the vaccine to keep their job.”

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After months of trying to persuade people to voluntarily get vaccinated, the White House might see mandates as a necessary step. However, Reich said continuing outreach and education efforts to alleviate doubts and correct misinformation among health care workers and others who remain unvaccinated is vital.

“Making people feel in control of this choice is really important,” she said.

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