Some health workers in state not getting vaccine
Employers say employees soon may not have choice
Not all Arizona health care workers are getting a COVID-19 vaccine, though in the future they may not have a choice: Some health systems say the vaccine eventually could become mandatory.
Of the Arizona health care employers who are tracking the vaccination rate in their workforce, or who provided estimates to The Arizona Republic, the range was 66.5% to 72.5% of their employees having received at least one dose of the COVID-19 vaccine.
Health experts say they’d like to have 70% to 90% of the population vaccinated, though the precise threshold for so
called herd immunity remains unclear for COVID-19. Herd immunity occurs when enough people are vaccinated to ward off future pandemics.
Multiple surveys on the subject have found health care workers tend to have similar attitudes as the general public when it comes to the COVID-19 vaccine, with about one in five saying they will not get the vaccine, according to one report released by a consortium of U.S. universities this month.
The health care workers who have been reluctant to get vaccinated aren’t necessarily against vaccinations in general. Rather, they worry about safety and the newness of the vaccine, and are concerned about side effects, surveys and studies have shown.
Hospitals and health care systems say they are encouraging, but not requiring, their workers to get a COVID-19 vaccine. The Republic did not identify any health care entities that are requiring their employees to get the vaccine, though some said they’d consider it in the future.
About 70% of Northern Arizona Healthcare’s employees have received the COVID-19 vaccine, and so far the biggest hesitation is a concern about side effects, the organization’s president and CEO Flo Spyrow said during a Feb. 15 news briefing.
“When we look at how that breaks down, from an employee perspective, most of our nurses and our physicians have become vaccinated,” Spyrow said. “The hesitancy is more in the areas of our housekeepers, for instance, or dietary workers, who have not gotten the vaccine in as high as a percentage as our clinical workers have.”
Health care workers in Arizona were in the top priority 1A group to receive the vaccine when the rollout began in December. The category of health care worker includes, among others, doctors, nurses, pharmacists, emergency medical technicians, paramedics, dentists, and health care support occupations, including home health aides, nursing assistants and medical assistants.
“The sense that I have within Valleywise Health is the majority of our team have taken the vaccine,” Dr. Michael White, chief medical officer for Phoenixbased Valleywise Health, said at a Feb. 17 briefing.
“I don’t have an exact number of the percentage of our employees that have received vaccine and have not received vaccine . ... The health care workers that have chosen not to have the vaccine have done so for various reasons, but the opportunity has been there, which I’m very grateful for.”
Number vaccinated is unclear
Arizona’s updated COVID-19 vaccine plan estimates the health care workforce in the state includes about 254,061 people.
Yet many hospitals and health systems did not provide specific numbers and percentages of their Arizona health care workforce that’s been vaccinated to date. Dallas-based Tenet Healthcare Corporation, which operates Abrazo
and Carondelet Health Network medical facilities in Arizona, said in an emailed statement that “we do not plan to provide this number to the media.”
Officials with Phoenix-based Banner Health, which is Arizona’s largest health care delivery system, said they don’t know what percentage of its workforce has received the vaccine.
“Many of our employees were vaccinated at non-Banner vaccination sites, and we do not have line of sight into vaccinations of those individuals,” spokesperson Becky Armendariz wrote in an emailed statement.
Scottsdale-based HonorHealth said in a written statement that “a majority of HonorHealth employees have received the COVID-19 vaccine so far,” but that it’s difficult to have a complete picture because the vaccine is not required and some employees have been vaccinated outside of HonorHealth locations.
At Dignity Health in Arizona, officials are in the process of determining how much of its workforce has received the COVID-19 vaccine “as the vaccine registration platforms are being managed by the county and state health departments,” spokesperson Carmelle Malkovich wrote in an email.
Other hospitals and health systems were more specific. Tucson Medical Center officials said that 72.3% of its workforce had received the COVID-19 vaccine, and the Mayo Clinic in Arizona said 66.5% of its workforce had received at least one dose of vaccine and that 60% was fully vaccinated with two doses.
State health officials and health leaders in Maricopa and Pima counties could not provide those numbers, either, though Arizona Department of Health Services Director Dr. Cara Christ recently indicated that data could become available at some point.
A wait-and-see approach
Several
hospitals
and
health
care
systems in Arizona disclosed some vaccine hesitancy among their employees.
“Since the vaccine was not mandatory, we experienced a number of employees who adopted a wait-and-see attitude, but came around once they saw co-workers successfully receive their doses of the vaccine,” said Alex Horvath, vice president of human resources for TMC HealthCare, which operates Tucson Medical Center.
Some Dignity Health employees also took a wait-and-see approach, Malkovich wrote.
“We believe many of these employees began feeling more comfortable with the vaccine once our internal scientific peer reviews supported the safety and efficacy of the vaccine, and as our frontline health care workers began being vaccinated,” she wrote.
At the Mayo Clinic in Arizona, there was some initial vaccine hesitancy because the COVID-19 vaccine was new, officials said. Since late last year, the health system has been encouraging employees to submit questions to Mayo vaccine experts.
“We continue to provide education on the clear benefits of vaccine to our employees,” spokesman Jim McVeigh said.
Dr. Casey Clements, an emergency room physician at the Mayo Clinic in Arizona, said health care workers and members of the general public should not be afraid to ask questions and have concerns about the COVID-19 vaccine.
“There’s a lot of misinformation out there,” Clements said.
Before he saw the vaccine safety data on both the Pfizer-BioNtech and Moderna vaccines, Clements was skeptical and for a time, unsure whether he’d get a shot.
“Really when I was hesitant was back before November. For health care workers and physicians, when you don’t have data, it can be jarring to think about using something in a medical sense,” he said. “When the data came out, they didn’t cut corners in those studies. Once I was able to personally evaluate the data, I was very excited.”
One of Clements’ initial concerns was about whether or not the vaccine would actually work. The COVID-19 vaccine uses messenger RNA, or mRNA, which works by teaching the body’s cells how to make a protein that triggers an immune response.
“It’s OK to express concern about things that you are going to do for your own body,” said Clements, who has a Ph.D. in microbiology and immunity. “The trick is that we really have to critically look at the evidence behind what we’re doing.”
Clements is now vaccinated with both doses of COVID-19 and says nearly every physician he knows who has had the vaccine available to them has been vaccinated, too.
Dr. Ross Goldberg, the Arizona Medical Association president, was one of the first people in Arizona to receive the COVID-19 vaccine on Dec. 16 during an event hosted by the Arizona Department of Health Services and the Maricopa County Department of Public Health as a way of encouraging community members to get vaccinated.
Goldberg kept a video diary on Twitter of how he was feeling after both his first and second doses. He had no major side effects, but said he fielded a lot of questions about it from both the public and from health professionals.
“Overall there are some physicians that are hesitant, which is fine ... You are never going to get 100% anything, but I think a large percentage of the physician community was interested, wanted to do it, and wanted to be good role models for everyone else,” said Goldberg, who is a general surgeon at Valleywise Health. “Others waited a little bit to see how people would do.”
Because he was so public about getting the COVID-19 vaccine, Goldberg says co-workers and others are always asking him about his experience, and about how he’s feeling. He had no reaction, missed no work, and said he’s feeling good. He’s heard various reasons for
why people might be hesitant, though he pushes back when he hears people say there’s not any long-term data.
“If we needed to wait for long-term data, we’d get no new medications for five or 10 years,” he said. “This is also unusual circumstances, a pandemic. So do I want to get COVID or deal with something that should be OK?”
Goldberg knew that a lot of prior research had been done on mRNA, he said, and he also read the COVID-19 vaccine safety reports from the drug manufacturers.
“It’s not like they came up with the idea of mRNA as a new phenomenon in 2020. That’s not the case. It’s just that the technology and the finances were there to get it over the finish line,” he said.
Gift cards as incentives to get vaccinated
Overall, health care workers’ attitudes about the COVID-19 vaccine are “very similar” to society overall, according to a report released this month by a consortium of researchers at Northeastern University, Harvard University, Rutgers University, and Northwestern University.
In a national survey of 25,640 individuals, including 1,797 health care workers across the country, the researchers found 21% of the health care workers said they would not get the COVID-19 vaccine, which closely matches the response given by 23% of nonhealth care workers they surveyed.
“Healthcare workers represent a microcosm of U.S. society, and a consequential one. They are polarized in terms of income and education, ranging from physicians with extensive postgraduate education, to cleaning staff with less than a high school education,” the report says.
More educated respondents are far more likely to be vaccinated, the report says, with far lower levels of vaccine hesitancy and resistance. Respondents with a high school diploma or less reported the highest level of resistance and those with graduate degrees reported the lowest.
A study of 11,460 skilled nursing facilities with at least one vaccination clinic conducted during the first month of the CDC Pharmacy Partnership for LongTerm Care Program, a median of 77.8% of residents and 37.5% of staff members received one or more vaccine doses through the program, according to a CDC report published Feb. 5.
Those percentages likely have gone up and seem to be rising in Arizona long-term care facilities among both staff and residents, said Dave Voepel, who is executive director and CEO of the Arizona Health Care Association, a professional long-term care association and advocacy group.
Voepel said he was at an Arizona long-term care facility this week that was having its third vaccination clinic. Slightly less than 70% of the staff was vaccinated, he said, and about 85% to 90% of the residents had received at least one vaccine.
Some long-term care facilities in Arizona are offering gift cards and one is considering one paid day off as incentives for staff to get vaccinated, he said.
One of the best approaches to increasing vaccine uptake Voepel has observed was at a skilled nursing facility in Tucson that began its staff and resident vaccine education program in November. When the vaccine first came out, the nursing home’s entire executive leadership team got immunized in a collective show of confidence, Voepel said. Now more than 90% of staff and residents at that nursing home are vaccinated, he said.
“We were hoping for 75% to 80% on the staff side,” he said. “Some have reached that ... Once people start talking it through, they get more and more educated and more comfortable and by the second or third vaccination clinic they are able to come to grips with it and
able to get it, so that helps.”
Voepel said some of the hesitancy is driven by misinformation, including worries about fertility and confusing mRNA for DNA, believing that the vaccine will alter one’s genetic composition.
The FDA says there is no scientific evidence to suggest that the vaccine could cause infertility in women. Federal officials say infertility is not known to occur as a result of natural COVID-19 disease, which shows that immune responses to the virus, whether induced by infection or a vaccine, are not a cause of infertility.
“I was at a clinic in January and I was asking a couple of CNAs (certified nursing assistant) that I was standing next to and I asked why they weren’t getting the vaccine,” Voepel said. “They said it came out too quickly. They want to wait and see. They want to see how everyone does with it and then they might get it at that point if everything seems safe.”
Hospitals could mandate the COVID-19 vaccine for employees
Hospitals and health systems aren’t requiring their employees to get the COVID-19 vaccine and several in Arizona told The Republic that one of the reasons is that the vaccine has emergency use authorization from the U.S. Food and Drug Administration, but not final clearance.
Others said they are waiting for a recommendation from the Centers for Disease Control and Prevention to consider a mandate.
Many hospitals and health systems in Arizona and across the U.S. for years have mandated that their employees get a flu vaccine. Those employees who don’t get a flu vaccine for medical or religious reasons have always had to wear a mask during flu season.
Valleywise Health in Phoenix mandates the flu vaccine for its employees, but “given the current approval status” of the COVID-19 vaccines available, the COVID vaccine, “is not mandatory,” said White, the chief medical officer.
“As more data is available, FDA approval status changes, this may change in the future,” he said.
Similarly, Banner Health requires its employees to have a flu vaccine unless they file for an exemption due to medical or religious reasons, Armendariz said. It is possible that the COVID-19 vaccine, like the flu shot, may become mandatory for Banner employees in the future, she said.
Vaccine mandates have been legal in the U.S. for decades
Both the federal Occupational Safety and Health Administration and the Equal Employment Opportunity Commission have previously approved employer-mandated influenza vaccinations that comply with anti-discrimination laws, according to the nonprofit
Network for Public Health Law.
Vaccine mandates for health care workers are often justified legally by balancing competing interests between assuring public and workplace safety versus respecting health care workers’ vaccine concerns, according to a Dec. 18 network analysis by Jen Piatt, senior attorney with the Western Region Office of the Network for Public Health Law at Arizona State University’s Sandra Day O’Connor College of Law in Phoenix.
According to her analysis, the key determinants of whether a COVID-19 vaccine will be mandated among health care workers in the future includes:
Proof of the vaccine’s efficacy and safety.
Specific
FDA.
Review and recommendations from the CDC’s Advisory Committee on Immunization Practices.
Additional clarifications from the EEOC and OSHA.
State- or local-based orders to issue mandates.
Emerging guidance from public and private sector employees as to the perceived or actual need of widespread vaccination among employees to assure their safety as well as patients and staff.
The public health law network also says that subject to some limits and exceptions, such as employees with disabilities who are at risk for harm from vaccines, non-health private sector employers may be able to legally require employees to get a COVID-19 vaccine,
authorization
from
the
emergency too.
“The perception that private sector, non-health care entities cannot mandate COVID-19 vaccines among their employees is seriously questionable,” James Hodge Jr., director of the network’s Western Region Office, wrote in an email. “Practical limitations, however, stand in the way of wider mandates, specifically a general lack of access to vaccines currently. There is little reason to mandate employees be vaccinated when state and local governments have insufficient doses to provide them, and private employers cannot secure their own PODS (point of distribution sites) to this end.”
Public- and private-sector vaccine mandates generally have been accepted in the U.S. for decades, “especially in public health emergencies,” ever since a 1905 U.S. Supreme Court decision upheld a smallpox vaccination mandate, Piatt said.
In that decision, the analysis states, the court acknowledged that “state and local governments are authorized to enact reasonable laws or regulations to protect public health and safety, including tailored vaccine requirements for persons who would not likely be harmed directly by the vaccination itself.”
Texas on Tuesday became the biggest state to lift its mask rule, joining a rapidly growing movement by governors and other leaders across the U.S. to loosen COVID-19 restrictions despite pleas from health officials not to let their guard down yet.
The Lone Star State will also do away with limits on the number of diners who can be served indoors, said Republican Gov. Greg Abbott, who made the announcement at a restaurant in Lubbock.
The governors of Michigan, Mississippi and Louisiana likewise eased up on bars, restaurants and other businesses Tuesday, as did the mayor of San Francisco.
“Removing statewide mandates does not end personal responsibility,” said Abbott, speaking from a crowded dining room where many of those surrounding him were not wearing masks. “It’s just that now state mandates are no longer needed.”
A year into the crisis, politicians and ordinary Americans alike have grown tired of rules meant to stem the spread of the coronavirus, which has killed over a half-million people in the United States. Some places are lifting infection control measures; in other places, people are ignoring them.
Top health officials, including the head of the Centers for Disease Control and Prevention, have responded by begging people repeatedly not to risk another deadly wave of contagion just when the nation is making progress in vaccinating people and victory over the outbreak is in sight.
U.S. cases have plunged more than 70% over the past two months from an average of nearly 250,000 new infections a day, while average deaths per day have plummeted about 40% since mid-January.
But the two curves have leveled off abruptly in the past several days and have even risen slightly, and the numbers are still running at alarmingly high levels, with an average of about 2,000 deaths and 68,000 cases per day. Health officials are increasingly worried about virus mutations.
“We stand to
completely
lose
the hard-earned ground we have gained,” CDC director Dr. Rochelle Walensky warned on Monday.
Even so, many Americans are sick of the shutdowns that have damaged their livelihoods and are eager to socialize again.
An Indianapolis-area bar was filled with maskless patrons over the weekend. In Southern California, people waited in lines that snaked through a parking lot on a recent weekday afternoon for the chance to shop and eat at Downtown Disney, part of Disneyland. (The theme park’s rides remain closed.) And Florida is getting ready to welcome students on spring break.
“People want to stay safe, but at the same time, the fatigue has hit,” said Ryan Luke, who is organizing a weekend rally in Eagle, Idaho, to encourage people to patronize businesses that don’t require masks. “We just want to live a quasi-normal life.”
Michael Junge argued against a mask mandate when officials in the Missouri tourist town of Branson passed one and said he hasn’t enforced it in his Lost Boys Barber Company. He said he is sick of it.
“I think the whole thing is a joke honestly,” he said. “They originally said that this was going to go for a month and they have pushed it out to indefinitely. … It should have been done a long time ago.”
In San Francisco, an upbeat Mayor London Breed announced that California gave the green light to indoor dining and the reopening of movie theaters and gyms.
“You can enjoy your city, right here, right now,” she said from Fisherman’s Wharf, one of the city’s biggest tourist attractions. She added: “We are not where we need to be yet, but we’re getting there, San Francisco.”
Mississippi Gov. Tate Reeves said he is getting rid of most mask mandates and lifting most other restrictions, including limits on seating in restaurants, starting Wednesday.
“The governor’s office is getting out of the business of telling people what they can and cannot do,” the Republican said.
Florida, which is getting ready for spring break travelers to flock to its sunny beaches, is considered to be in an “active outbreak,” along with Connecticut, Delaware, Georgia, New Jersey, New York, Rhode Island and South Carolina, according to the data-tracking website CovidActNow.
Florida Gov. Rick DeSantis made it clear during his annual State of the State address Tuesday that he welcomes more visitors to Florida in his drive to keep the state’s economy thriving.
Florida municipalities can impose their own mask rules and curfews, restrict beach access and place some limits on bars and restaurants, but some have virtually no such measures in place.
Miami Beach will require masks indoors and out and restrict the number of people allowed on the beach as well as in bars and restaurants.
“If you want to party without restrictions, then go somewhere else. Go to Vegas,” Miami Beach City Manager Raul Aguila said during a recent virtual meeting. “We will be taking a zero-tolerance attitude towards that behavior.”
In Michigan, a group called All Business Is Essential has resisted Gov. Gretchen Whitmer’s virus policies, and many people are ignoring mask requirements and other measures, said group leader Erik Kiilunen.
“At some point you’ve got to look yourself in the mirror and say, ‘Do I want a zero-risk life?’ ” he said. “It’s become a farce, really. People have quit living for a year, at what price?”
“I think everybody wants things to get back the way they were,” said Aubrey D. Jenkins, the fire chief in Columbia, South Carolina, whose department issues dozens of $100 citations every weekend to bar-goers who refuse to wear masks or keep their distance. “But we still have to be real cautious.”