USA TODAY US Edition

Vaccine divisive even in hospitals

Do health workers’ duties outweigh right to say no?

- Elizabeth Weise

Over the past three weeks, state after state has passed some form of mandate requiring health care workers to be vaccinated against COVID-19.

Health policy experts expect the trend to continue as the delta variant ravages the country, and it may even speed up if the Food and Drug Administra­tion gives full approval to a vaccine, which could come within weeks.

Even for doctors and nurses whose mission is to protect the lives of their patients, the issue remains divisive. Does that duty to those patients trump their right to refuse vaccine?

At least 16 states require COVID-19 vaccine for some health care workers. In Arkansas, Montana, New Hampshire, North Dakota, Tennessee, Texas and Utah, there are prohibitio­ns on such mandates, according to the National Academy for State Health Care Policy.

Texas Gov. Greg Abbott issued an executive order July 29 prohibitin­g lo

cal government­s and state agencies from mandating vaccines. Officials in Dallas, San Antonio and Bexar County have sued to challenge Abbott’s authority to prohibit safety-related ordinances.

A new mother in Austin experience­d the conflict firsthand Wednesday.

Her obstetrici­an had assured her that most labor and delivery staff are vaccinated, but in a state where cases were up 34% in a week, she wanted to be sure, so she asked her nurse.

“Well, I can tell you, I’m not vaccinated,” the nurse at St. David’s HealthCare told her.

Not only did the mother have a newborn, she had a toddler at home who could not be vaccinated. Although the nurse was “profession­al and lovely,” the mom was appalled and angry her baby and family weren’t protected in a health care setting.

Hours after giving birth, she mustered the energy to request a different nurse.

“I’m in this room where I’m not allowed to get up out of bed without help from the nurse who’s not vaccinated. What can I do?” the mom, who asked not to be identified while still in the hospital, told USA TODAY Wednesday morning. “How am I supposed to feel safe with my baby here?”

Later in the day, she and her baby were assigned nurses who were vaccinated.

In a statement to USA TODAY, St. David’s HealthCare said it has strongly encouraged COVID-19 vaccinatio­ns for all staff but does not require them. It follows all Centers for Disease Control and Prevention guidance on safety protocols as well as requiring masking of all staff, patients and visitors. The Texas governor’s order does not affect St. David’s because it is a private company.

For states requiring vaccinatio­n, the first, and strictest, order was issued last week by California Gov. Gavin Newsom. It requires all health care workers to be fully vaccinated against COVID-19 by Sept. 30. Those without medical or religious exemptions who aren’t vaccinated risk losing their jobs. Wednesday, Newsom went further, requiring all California teachers and staff to receive vaccinatio­n or undergo weekly testing.

Most of the state mandates are issued as executive orders, said Hemi Tewarson, executive director of the National Academy for State Health Policy.

Neither the president nor the federal government can mandate vaccines at the state level, said Dr. Howard Koh, a professor of public health at the Harvard Chan School of Public Health and former assistant secretary for health under President Barack Obama.

More than 140 hospitals and health systems have individual­ly mandated vaccines for their employees, according to a list kept by Becker’s Hospital Review.

Such mandates are supported by the American Medical Associatio­n, American Nurses Associatio­n, American Academy of Pediatrics, Associatio­n of American Medical Colleges and National Associatio­n for Home Care and Hospice.

Koh expects more state mandates will follow. “All states are watching what their peers are doing. The more it becomes the norm, the more other states and governors will follow,” he said.

Because children under 12 can’t be vaccinated, “people who are declining the choice of vaccinatio­n are endangerin­g the health of young kids who have no choice. It’s all interconne­cted. These governors understand that very clearly,” he said.

The California mandate includes people who work in hospitals, nursing facilities, psychiatri­c hospitals, clinics and doctor’s offices, as well as kidney dialysis centers, substance use treatment centers and hospices.

LifeLong Medical Care is a network of 15 clinics across three Northern California counties with more than 1,000 staffers. About 65% of them are fully vaccinated, said deputy chief medical officer Magdalen Edmunds.

“It’s certainly something we’ve heard, that people were saying they were going to wait until it was mandated and then they’d get vaccinated,” she said.

The network focuses on underserve­d and vulnerable communitie­s hit hard by COVID-19. “Our staff are also the community and the families we serve,” she said. The more of them who are vaccinated, she said, the more it will be normalized and help the rest of the community understand the vaccines are safe, effective and necessary.

In California, small protests against the vaccinatio­n requiremen­t have been held in Redding, Riverside, Loma Linda and San Diego.

Monday, dozens of protesters gathered at the opening of an expanded maternity pavilion and children’s hospital at Loma Linda University Medical Center in Southern California.

Many of the rallies are organized via social media, and there is no official organizati­on putting them together. Online flyers refer to “America’s Healthcare Workers for Medical Freedom,” but no nonprofit group or political action committee by that name is registered.

The California Nurses Associatio­n, which represents 100,000 RNs in the state, “supports mandates with appropriat­e accommodat­ions for those who have medical and religious needs” the group said in a statement.

The Service Employees Internatio­nal Union Local 521, which represents many hospital, home care and nursing home workers, supports COVID-19 vaccinatio­n but wants to make sure workers are part of the negotiatio­ns on how shots are implemente­d.

“When workers are involved and have a voice in workplace health decisions, everyone including the public we serve, is safer,” said Riko Mendez, SEIU Local 521 chief elected officer.

The right of states to mandate vaccinatio­n goes back as far as 1905, when a Cambridge pastor named Henning Jacobson refused to be vaccinated against smallpox, which was required by law in Massachuse­tts, and he was fined $5.

Henning’s case made it to the U.S. Supreme Court, which upheld the authority of states to enforce vaccinatio­n laws “to protect the public health.”

Medical and religious exemptions from COVID-19 vaccine mandates are available.

The bar is higher for medical exemptions than religious ones, said Dorit Rubinstein Reiss, a law professor at the University of California Hastings College of Law in San Francisco.

“The standard isn’t whether an organized religion objects to vaccines but whether you as a religious person have a sincere objection,” she said.

For example, the Vatican has said COVID-19 vaccines are acceptable, but if a Catholic said, “I feel differentl­y,” it would be the individual’s personal belief that counted, she said.

One objection has been that COVID-19 vaccines were issued under an emergency use authorizat­ion by the Food and Drug Administra­tion, rather than the usual full approval.

Last month, the Department of Justice said employers and public entities could mandate COVID-19 vaccines under emergency authorizat­ion.

Presidenti­al adviser Anthony Fauci said Sunday that the FDA will issue full approval for the Pfizer-BioNTech COVID-19 vaccine probably by the end of the month.

“As soon as one vaccine is licensed, it’s going to be hard to argue against the mandate,” Reiss said.

It doesn’t surprise Reiss that some states go with soft mandates, requiring either vaccinatio­n or testing.

“They’re calculatin­g the cost of litigation versus the cost of an outbreak onsite,” she said.

Health care workers are singled out for vaccinatio­n mandates because they are on the front line of caring for others, said Harvard’s Koh. It’s the same reason the COVID-19 vaccines were offered to them first.

“Protecting people’s health is part of our mission, whether it’s a doctor, a nurse, a nursing home provider or a home health aide,” he said. “People don’t want health care workers to be vectors of transmissi­on when their work is to protect against disease.”

 ?? BRYAN TERRY/USA TODAY NETWORK ?? COVID-19 vaccine is administer­ed at a clinic inside the Meinders NeuroScien­ce Institute in Oklahoma City on July 23.
BRYAN TERRY/USA TODAY NETWORK COVID-19 vaccine is administer­ed at a clinic inside the Meinders NeuroScien­ce Institute in Oklahoma City on July 23.

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