The Healthcare Industry's Struggle with the COVID Vaccine
The Issue
While the vaccines have proven to be effective against contracting COVID-19, severe illness, and death, studies are still being conducted to determine if the vaccine keeps the viral load low enough to prevent transmission. Despite the good news, an alarming number of healthcare professionals are refusing to be vaccinated. This places the organization under potential financial and legal consequences if their staff contracts COVID-19 at work or spread it to clients and patients. Three main groups of healthcare recipients exist; those that support vaccination, those that need answers to their questions first, and those that refuse to be vaccinated. Unfortunately, the latter two groups create gaps in the number of healthcare workers receiving the vaccine, ranging from only 40% to 60% willing to receive one. This is a broad gap from the necessary 75-80% needed for herd immunity.
“If 75 percent to 80 percent of Americans are vaccinated, then by the end of 2021, we can reach a degree of normality,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
Also, since the vaccines have not proven to prevent the transmission of the virus, masks, social distancing, and other preventative measures need to remain in place. General COVID fatigue is frustrating recipients into wondering if the unknowns are worth risking the vaccine in the first place.
The Reality
A New York survey reported that 85% of non-physician staff favor getting the vaccine and a higher percentage of physicians. In Ohio, 40% of nursing home staff took the vaccine. Some facilities are seeing as much as an 80% refusal rate to taking the vaccine.
Many healthcare workers appear to be as susceptible to false information regarding the vaccine as the general public. Main concerns include the speed at which the vaccine was produced, despite following regulations, and rumored side effects despite no significant data supporting long-term detrimental effects.
The most common side effect of the vaccine is hope, as reported in the Vaccine Adverse Event Reporting System. Hope is more prevalent than a headache, site pain, or fatigue. The vaccines have been issued safe for use under a EUA statement or Emergency-use Authorization. EUAs require significantly more data on efficacy and safety than the typical full licensing. Currently, efficacy for all US approved vaccines have proven to be above 94% against COVID-19, and none show serious side effects. Common side effects are similar to those experienced with other vaccines, like fatigue, injection-site soreness, chills, and headaches.
The second dose has proven to produce low-grade fevers and muscle aches in about 50% of the recipients. This is not a cause for medical experts’ concern but rather proof that the vaccine is triggering an immune response. Currently available vaccines do not contain COVID-19, but they contain mRNA genetic molecules to create the needed immune response, which attacks the coronavirus. While the vaccine is highly effective, recipients should not stop precautionary measures after their first or second dose. There is a time element to the vaccine’s efficacy rate, and there is not enough data to support with certainty that those who are vaccinated cannot transmit the virus. Finally, the length of time the vaccine will be effective is unknown at present since the trials are only months in length.
For those waiting to be vaccinated and healthcare workers who allowed their window of opportunity to pass, alternate locations will continue to be made available. Those locations will be certified in caring for, storing, and administering highly fragile vaccines. So, whether the vaccine is received from a physician or at a pharmacy, the dosage will be administered correctly and safely.
For those concerned with worst-case scenarios and what-ifs, the federal government has created a Countermeasures Injury Compensation Program (CICP) to cover injury from the vaccine or its administration. This is supplemental to the National Vaccine Injury Compensation Program and the individual’s insurance coverage. These programs are designed to cover specific medical costs associated with the vaccine, its administration, and any wage loss.
There is a significant additional risk if certain populations choose not to be vaccinated or do not have access to a vaccine. Each time the COVID-19 virus replicates, there is a chance for it to mutate. While most mutations are harmless, others can increase the virus’s transmissibility and/or virulence, thereby increasing lethality. The longer the virus is in circulation, the greater the risk of harmful mutations. The most viable solution is widespread vaccination, which will create herd immunity and curtail the virus’s transmission within a population.
The Resolution
At this time, the federal government has made it possible for organizations and employers to mandate vaccinations; however, it does not appear popular. While employers do not want to force employees to receive the vaccination, they also do not want to expose their company to further exposure of their personnel and clients to those who wish not to vaccinate. Since the Department of Health and Human Services declared COVID-19 a potential threat to national security in February 2020, paving the way for the EUA. The negative effects of the vaccine are “known and potential benefits outweigh the known and potential risks, supporting the vaccine’s use in millions of people 16 years of age and older, including healthy individuals.” The issuance of the EUA for this vaccine paves the way for legally mandating vaccine receipt. However, little if any guidance at either the federal or state level has been provided.
Leaders may encourage participation through other measures. Education appears to be key to compliance. Educating staff on the studies conducted, current side effects, and effectiveness goes far in dispelling fears caused by popular social media myths and rumors, of which, even health professionals are subjected. The CDC issued a “confidence checklist” to help encourage workers to accept the vaccine. The checklist can be used to educate staff as well.
While many companies refuse to mandate vaccinations, healthcare organizations are better positioned to instate stronger measures. “Stated differently, healthcare employers should have little difficulty concluding, based on objective evidence, that any employees who potentially have contact with other employees, patients, or residents should, as a general rule, take approved COVID-19 vaccinations.” If healthcare organizations choose to go in this direction, they should consider analyzing which jobs pose the most threat for transmission of the virus, who can choose to work remotely or go on leave until the policy changes and establish consistent protocols for those seeking to waive this requirement.
When designing these policies, healthcare leaders should consider whether continued exposure negatively affects the organization’s ability to serve non-COVID patients, such as elective procedures and admission to long-term care facilities. Finally, leaders must consider whether current contractual and other business relationships will require such a mandate.
COVID-19 will be here for the foreseeable future, and its impact continues to throw new curves at the healthcare industry. A vaccine can begin decreasing the pandemic’s impact, but not until most people agree to take it, especially those working in the healthcare industry. To encourage staff to voluntarily receive the vaccine, leaders can educate employees about potential side effects, short- and long-term implications, and evidence-based information regarding the virus and related vaccine. The more transparent leaders are about the pandemic’s challenges and implications, the more confidently staff may manage their vaccination decision.