Amid a COVID-19 surge fueled by the delta variant, U.S. hospitals are increasingly requiring vaccination for employees — and taking an array of approaches to offering them.
The number of hospitals with coronavirus vaccination policies for their workforces as of Aug. 18 was about 2,150, up from zero 4½ months ago, according to an estimate from the American Hospital Association.
The association could not specify how many of these policies require vaccination as a condition of employment, but it seems like a majority of them do, with certain exemptions for religious and medical reasons, said association spokesperson Colin Milligan.
Healthcare organizations are taking other approaches, too. Rochester, Minn.-based Mayo Clinic, for example, is requiring its staff to be fully vaccinated by Sept.17 or undergo a refusal process. Those who do not meet the deadline must complete education modules, wear face masks and maintain social distancing while on campus.
"We have heard of hospitals asking that unvaccinated employees take certain extra safety measures not required of vaccinated staff, such as ensuring a minimum distance away from fellow staff if they are eating a meal [which obviously requires taking off a mask], or not using an on-site gym," Mr. Milligan said. "A few systems also require that unvaccinated staff undergo regular COVID-19 testing before they are able to report for work."
Becker's, which has been reporting vaccination requirements, spoke with healthcare institutions about their strategies behind deciding to mandate, as well as the reasons for the approaches they chose and how they're handling any pushback from employees.
Condition of employment
Allina Health, an 11-hospital system based in Minneapolis, said Aug. 3 that the COVID-19 vaccine will be a condition for employment. All employees, volunteers, students and contractors will be required to have had at least one vaccine dose by Oct.1, with limited exemptions for medical and religious reasons. As of Aug. 13, 74.5 percent of Allina Health employees had completed their first dose.
Ryan Else, MD, vice president and clinical officer for Allina Health, said the decision to mandate as a condition of employment fits within the organization's mission to prevent illness.
"We continue to see COVID-19 spread and delta increasing in Minnesota. And knowing how safe and effective that vaccine is — and, also, recognizing our mission is to prevent illness and lead our community — we felt it really important we take the position for our employees, not only to protect them but also make it clear to our communities that this vaccine is safe and is our path out of this pandemic," said Dr. Else.
Since December, he said Allina Health has continued to encourage the vaccine and has had several educational sessions available online and forums to talk about the safety of the vaccine. But the health system saw a significant share of employees who were not being vaccinated and has seen lagging vaccination in the community, said Dr. Else, and "felt this was the most important initiative around the vaccine."
Overall, he said Allina Health has been pleasantly surprised by the overwhelming support or encouragement by many staff about vaccination.
Lebanon, N.H.-based Dartmouth-Hitchcock Health, which has about 13,000 employees, announced Aug. 3 that it will require employees to get vaccinated as a condition of employment, effective Sept. 30. The health system said employees must submit documentation that they have been fully vaccinated or obtain an approved medical or religious exemption.
Joanne M. Conroy, MD, CEO and president of Dartmouth-Hitchcock Health, said the organization has strongly encouraged employees to be vaccinated since vaccines became available in late 2020. Between then and Aug. 13, 80 percent of its workforce had voluntarily been fully vaccinated, she said.
"While we deeply appreciate this vast majority of our staff making this choice for the safety of our patients and community, in order to ensure our hospitals and clinics are as safe as possible and that we’re doing our part to end this pandemic, we made the decision that vaccination as a condition of employment was the best and fastest way to achieve a 100 percent vaccinated workforce. The data and science clearly support the benefits of vaccination," said Dr. Conroy.
Being the largest healthcare provider in New Hampshire, the state's only academic medical system and the state's largest private employer, sets Dartmouth-Hitchcock Health apart "and positions us as leaders in public health here in New Hampshire," she said.
"We take that responsibility very seriously, and this was absolutely something we considered as we reached this decision [to mandate as a condition of employment]," she added. "The emergence of the highly contagious delta variant of COVID-19 also contributed to the choice to require vaccination for employees. The data to date suggest that the three vaccines currently in use in the U.S. — the Pfizer-BioNTech, Moderna and Janssen/Johnson & Johnson vaccines — provide good protection against the delta variant, especially against the worst outcomes, including hospitalization and death."
The decision to require vaccination against COVID-19 by all employees is supported by the New Hampshire Hospital Association, Dr. Conroy said.
When voluntary vaccination is declined
Mayo Clinic revealed its vaccine mandate July 26. The health system said it's transitioning into the next phase of its COVID-19 vaccination program. The program mirrors the approach Mayo Clinic takes for annual flu vaccinations.
Those who do not get vaccinated will be required to complete education modules and a declination form. Unvaccinated team members will be required to wear a mask at all times in all buildings on all Mayo campuses. Employees who do not get vaccinated or complete the process of declining to be vaccinated by Sept. 17 will be placed on unpaid leave.
Mayo told Becker's it went with a declination option because it was the most expedient route to increase vaccination rates among its staff. It said it will continue to evolve its strategy. Even though Mayo gave the option of a declination process, it isn't prohibited from moving to mandatory vaccinations, the health system stated. Mayo Clinic stated it may look at other options if its current mandate does not sufficiently increase vaccination rates at the level needed to protect its patients and staff.
Georgetown, S.C.-based Tidelands Health mandated vaccination for employees, employed providers, volunteers, learners and contractors. Employees have until Sept. 7 to comply, and the health system is providing an attestation and declination process for those who cannot get vaccinated for medical or religious reasons.
The health system told Becker's that like its affiliate, Charleston, S.C.-based MUSC Health, it allows team members who have a previously documented COVID-19 infection to decline vaccination. The decision was based on research with MUSC's COVID-19 Epidemiology Intelligence Project, which found that natural immunity and vaccine immunity are equivalent across its communities, the spokesperson said.
MUSC updates its data regularly, according to the spokesperson.
"If at any time research shows natural immunity is beginning to wane, team members who have declined the vaccine on the basis of previous infection will be required to receive the COVID-19 vaccine to remain in compliance with policy," the spokesperson told Becker's.
'Leaving it up to the market'
Cincinnati-based Mercy Health told Becker's it is deciding whether to mandate vaccinations by market.
"The Cincinnati [and Kentucky] market of Mercy Health will require vaccines; however, as a ministry, Bon Secours Mercy Health is not requiring vaccines at this time, " Maureen Richmond, vice president of integrated communications, told Becker's. "We are leaving it up to the market."
Mercy Health said each of its employees is critical for supporting the needs of its patients and that their health and safety remain among its top priorities.
Mercy Health said in an Aug. 5 news release shared with Becker's that requiring vaccinations in some markets will help with staffing shortages because the Occupational Safety and Health Administration requires unvaccinated healthcare employees to stay home from work if they have been exposed to COVID-19, regardless of whether they have symptoms.
Not mandating vaccinations
Some reputable healthcare institutions have held back on vaccination requirements, including Cleveland Clinic, Pittsburgh-based UPMC and Chicago-based Northwestern Medicine. Cleveland Clinic and Northwestern Medicine said they are focusing on understanding vaccine hesitancy among staff.
"For our unvaccinated employees, we are trying to get a better understanding of why they have not received the vaccine," Chris King, the director of media relations and communications at Northwestern Medicine, told Becker's. "Is there a medical reason or religious exemption? If those are not the reason, then we want to create an environment where we can provide information and learning opportunities to educate any employee that may have questions or concerns on being vaccinated."
Pittsburgh-based UPMC told Becker's it recognizes that vaccination and targeted mask use are key strategies in quelling the COVID-19 pandemic. UPMC said it will continue its vaccine advocacy and outreach efforts and make vaccinations easily and readily available for all.
Handling pushback from employees
Vaccination mandates have received pushback from some employees. Workers have protested vaccination requirements, citing the desire for choice. They have particularly opposed firings of unvaccinated healthcare workers. Houston Methodist, the first health system to mandate vaccination for employees, has had two lawsuits filed against the organization over its mandate.
Dr. Else, with Allina Health, said the organization does see pushback and a lot of questions being asked. At this time, he said the health system is hosting forums and educational sessions with workers, connecting with staff and addressing any concerns about vaccinations related to pregnancy, fertility and lactation.
Allina Health is also "keeping all of our information online and providing the most accurate, up-to-date information," said Dr. Else.
"I think our job as a healthcare provider and as an employer is to be available and provide the most current information as possible. I'm proud we're doing everything we can to communicate that across the organization," he added.
Bob Riney, president of healthcare operations and COO of Detroit-based Henry Ford Health System, also spoke with Becker's in July about handling pushback.
He said: "The first thing we're doing is sticking to our values, which is treating people with respect, whether they view our mandate as something they agree with or not."
Amid concerns from some employees, Henry Ford is offering communications in the health system's internal electronic newsletter related to vaccination and providing information about the science and data behind vaccines, among other efforts, he said.