As covid-19 vaccination mandates gain momentum, Pa. health care workers remain largely free to decide

Only one major Pennsylvania health care employer, Philadelphia-based Penn Medicine, has required employees to get vaccinated against covid-19.

But mandates are under consideration at others.

“We haven’t gotten to the mandate yet. We think about it and we assess where we’re at, but we haven’t made that decision yet,” said Dr. Donald Yealy, the chair of emergency medicine at UPMC.

Covid-19 has surged all over the country this summer, driven by the delta variant, considered 2-3 times more contagious than previous strains. Hospitals are full in some parts of the United States with lower vaccination rates.

Recent weeks have brought a burst of large employers requiring employees to get vaccinated. These include Facebook, Google, the Walt Disney Co., the NFL and the federal government as well as a smattering of major health care systems around the country. More and more local governments are announcing vaccination mandates for employees.

Some of the mandates require employees to choose between vaccination or keeping their job. Some require either vaccination or regular testing. Some allow religious and medical exceptions.

Earlier in the pandemic, health care organizations seemed among the least likely to need a vaccination mandate. Their employees had first access to the vaccines and were expected to wholeheartedly grasp the benefits and importance.

But vaccine misinformation and hesitancy has taken root even among health care workers.

Yealy recently said “roughly 70%” of UPMC’s 97,000 employees are fully vaccinated, with another 3% having begun the process.

“I don’t think it’s terrible, the vaccination rates, but I would not describe us as having the job completed,” he said.

Misinformation plays a role, he said.

Acting Pennsylvania Secretary of Health Alison Beam on Wednesday said Gov. Tom Wolf’s administration is “incredibly concerned about some of the low vaccination rates within our health care workforce,” with much of the concern involving nursing homes and state-run health care facilities.

Penn State Health said about 82% of employees and medical school students are fully vaccinated. Geisinger said “nearly 70%” of employees are fully vaccinated. WellSpan Health declined to give a figure. All noted they don’t require vaccination, but none ruled it out.

“We are continuously monitoring covid-19 trends and recommendations from state and federal officials, so while there are currently no plans to make covid vaccination mandatory for our employees it could change in the future,” Penn State Health spokeswoman Barbara Schindo said.

UPMC has more than 30 hospitals throughout Pennsylvania, with some located in rural counties with lower vaccination rates.

Yealy said the vaccination rate varies across UPMC locations. He noted vaccination levels among health care workers often track with the local population.

He said UPMC on a daily basis considers “what are the best tools to help people overcome the either hesitancy or outright refusal of vaccination.”

“We actually huddle closely with the leaders at our individual sites and regions to try to tailor the messages and activities to meet that local population,” he said.

UPMC also constantly considers actions including requiring employees to be vaccinated in order to keep their job or some “hybrid” involving options for unvaccinated employees.

“We have chosen not to use those right now because we believe that the opportunities to enhance vaccination through education, ease and availability still offer us a lot of opportunities,” Yealy said.

He stressed that so far UPMC has a good record of protecting both patients and employees from infection.

Among health care workers, vaccination appears highest, by far, among physicians.

The American Medical Association in June released a survey showing 96% of physicians were fully vaccinated. The AMA further noted that of the unvaccinated physicians, 45% planned to get vaccinated.

While the figure isn’t specific to Pennsylvania, the AMA said it found “no significant difference in vaccination rates across regions.”

Pennsylvania lacks its own data on vaccination rates among health care workers, instead pointing to sources such as the AMA and the U.S. Centers for Disease Control and Prevention.

One surprisingly low level of vaccination involves nursing home workers.

According to the CDC, 60.3% of Pennsylvania nursing home workers are fully vaccinated, with another 1.2% partially vaccinated. That’s actually slightly below the national average for nursing homes and no better than the overall level of vaccination among Pennsylvania adults, about 63%.

On one hand, the burst of companies opting for mandates is expected to open the door to more, because companies now know they can do so without attracting a national spotlight.

On the other, observers note the companies that have imposed mandates so far have mostly white-collar workforces who might not be willing to go to the office if they’re at risk of being around unvaccinated people.

But mandates are far less common among blue-collar employers, which face a severe worker shortage and might lose workers if they require vaccination.

Pennsylvania nursing homes are among the employers facing a labor crisis.

The Pennsylvania Health Care Association, which represents for-profit nursing homes, has taken no position on mandates, saying it trusts homes to decide whether to mandate vaccination or keep it voluntary.

“Our providers know their workers and residents best, and amid a challenging workforce shortage, they have continued to make the decisions that promote the high-quality care they provide, each and every day,” PHCA CEO Zach Shamberg said.

However, the board of directors of LeadingAgePA, which represents non-profit nursing homes, on Wednesday “encouraged” its members, and all health care organizations, to mandate vaccination. It said some of its members have already mandated vaccination for staff.

The main protection for Pennsylvania nursing home residents comes from the fact that 83% are vaccinated.

But LeadingAge noted, “Even fully vaccinated older adults in long-term care settings have shown to be at risk with the new variants of covid emerging and the presence of unvaccinated staff.”

The fact that vaccines are still being given under an emergency use authorization, rather than full approval, may be causing some employers to hold back on mandates. That’s expected to soon change, with vaccine manufacturers seeking or preparing to seek full approval. Pfizer, for example, is expected to receive full approval as soon as late summer.

Asked what it would it take for UPMC to impose a mandate, Yealy said it would take a variety of factors such as serious local outbreaks.

Overall, Yealy believes vaccination mandates are “an important tool to consider” for health care employers.

He said the ultimate decision should center on what enables “the best care to the most patients.”

“You have to ask yourself, does a mandate help you achieve that?,” he said.