As a practicing infectious disease physician, one of the most frustrating aspects of the COVID-19 crisis has been poor vaccine uptake by health care workers. We should expect that all health workers are fully vaccinated. It would stand to reason those individuals with advanced training in health care, who have attested to their profession via an oath, would see the value of the vaccine, understand its efficacy and be acutely aware of the damage that COVID-19 can do to individuals and hospital capacity, but they are falling prey to the largely funded misinformation campaigns circulating widely.
On Thursday, President Biden took a critical step in requiring health care facilities that participate in Medicare and Medicaid programs to mandate vaccination as a condition of participation in this taxpayer-funded government health insurance program. It is not ideal that it came to this but, for too long, many hospital administrators have lacked sufficient courage or long-range vision to take this action on their own.
Health care workers are required to get many vaccinations including those against rubella, hepatitis B — and, at many hospitals, influenza. These vaccines not only protect health care workers, but also patients, make the workplace safer, and enhance the resiliency of the workforce. As such, there can be no legitimate argument that the COVID-19 vaccines — especially during a pandemic — are resoundingly accomplishing these goals. There is virtually limitless data showing that the COVID-19 vaccines available are safe and effective. Indeed, many people in the public are dumbfounded when they hear of low levels of hospital employee levels of vaccination. They, like me, expect it to be 100 percent.
I am on staff at several hospitals in the Pittsburgh-metropolitan area including one in my hometown. In the past week, issues regarding mandatory vaccination as a condition of employment became very acute for me and my vociferous and intransigent advocacy that the hospital institute a vaccine mandate as the hospital beds fill with COVID-19 patients and members of staff are out on isolation after exposures.
In some hospitals anti-vaccine forces are prevalent and emboldened by the presence of a nursing union, they are reticent to take the correct action for fear of a clash with the union, massive staffing shortages stemming from the unvaccinated no longer being employees, and competitors hiring the displaced unvaccinated nurses. So, in effect, placation of the unvaccinated is occurring.
Some hospitals are so fearful that they will not even distribute badges that indicate employee vaccination status — something I know patients and co-workers would want to know. It is also the case that if a hospital is inundated with COVID-19 patients, they have real concerns about their ability to operate without the unvaccinated as a part of their workforce. Ideally, hospitals in a region would act as a coalition and make a uniform policy of vaccine mandates. To date, that has largely not been the case, so Biden has stepped in to leverage his power and action he can take.
If a health care worker knowingly shuns these vaccines, they should leave the field. Modern hospitals are the products of science, rationality and reason. They are not a place where the voices of the Dark Ages can speak without challenge. If a hospital cannot function without the unvaccinated, they must reflect on what type of employees they attract. Unvaccinated health care workers have the potential to endanger patients and diminish the ability of hospitals, one of the keystones of pandemic preparedness, to function amid a deadly pandemic. Biden’s action is laudable, I only wish it occurred earlier and wasn’t necessary.
Amesh Adalja, M.D., is an infectious disease physician and a senior scholar at the Johns Hopkins Center for Health Security. Follow him on Twitter: @AmeshAA