Wednesday, 20 Jan 2021

Cash, Breakfasts and Firings: An All-Out Push to Vaccinate Wary Medical Workers

Anxious about taking a new vaccine and scarred by a history of being mistreated, many frontline workers at hospitals and nursing homes are balking at getting inoculated against Covid-19.

Anxious about their patients’ health and scarred by many thousands of deaths in the past year, hospitals and nursing homes are desperate to have their employees vaccinated.

Those opposing forces have spawned an unusual situation: In addition to educating their workers about the benefits of the Covid-19 vaccines, a growing number of employers are dangling incentives like cash, extra time off and even Waffle House gift cards for those who get inoculated, while in at least a few cases saying they will fire those who refuse.

Officials at two large long-term care chains, Juniper Communities and Atria Senior Living, said they were requiring their workers, with limited exceptions, to take the vaccine if they wanted to keep their jobs.

“For us, this was not a tough decision,” said Lynne Katzmann, Juniper’s chief executive. “Our goal is to do everything possible to protect our residents and our team members and their families.”

Critics say it is unethical to strong-arm low-paid workers into taking the vaccines, especially when there hasn’t been enough time to gather long-term safety data.

“This is a population of people who have been historically ignored, abused and mistreated,” said Dr. Mike Wasserman, a geriatrician and former president of the California Association of Long Term Care Medicine. “It is laziness on the part of anyone to force these folks to take a vaccine. I believe that we need to be putting all of our energy into respecting, honoring and valuing the work they do and educating them on the benefits to them and the folks they take care of in getting vaccinated.”

Workers at hospitals and nursing homes were among the first to become eligible to get inoculated against the coronavirus when the vaccines became available last month. Their hesitance has been one reason for the sluggish start to the U.S. vaccination drive. Only recently has the pace accelerated: Nearly half of the more than 10.3 million doses administered in the United States were given in the past week, according to the Centers for Disease Control and Prevention.

At Jackson Health System in Miami, a survey of about 5,900 employees found that only half wanted to get a vaccine immediately, a hospital spokeswoman said. Most of the rest said they would consider taking it at some point in the future. But about 880 employees said they were not interested in getting vaccinated at all.

Henry Ford Health System, which runs six hospitals in Michigan, said that as of Wednesday morning, about 22 percent of its 33,000 employees had declined to be vaccinated. Seventy percent have been vaccinated, a spokesman said.

Gov. Mike DeWine of Ohio said last month that roughly 60 percent of nursing home staff members offered the vaccine in his state had declined it. In New York City, at least 30 percent of health care workers resisted getting a vaccine in the first round of inoculations, Mayor Bill de Blasio said on Monday.

At Long Island Jewish Hospital in Forest Hills, Queens, respiratory therapists who intubate critically ill coronavirus patients are among those at highest risk of contracting Covid-19. Yet only three of the 19 full-time staff members in the hospital’s respiratory therapy department had agreed to get vaccinated.

The two vaccines being administered — one made by Pfizer, the other by Moderna — have undergone extensive testing on tens of thousands of people. Both have been found to be safe and highly effective. So why are so many hospital and long-term care workers reluctant to get inoculated?

Some speak of concern about the newness of the vaccines. Others are worried about how the vaccine might affect their health, especially those who are pregnant, have allergies or have already survived Covid-19. Underlying the hesitancy is a lack of trust in authorities — the federal government, politicians, even their employers — that have failed for the past year to get the virus under control.

Sherry Perry, a certified nursing assistant who works in a long-term care facility near Memphis, said she had talked to many nursing assistants around the country who were skeptical. Ms. Perry, who said she would probably take the vaccine eventually, said the doubts were a rational response to the way health care workers like her had been treated for a long time.

“We are left behind in the dust — no one sticks up for us,” she said. When Ms. Perry was bedridden for weeks with a bad case of Covid-19, she said, she had to use vacation days to cover some of her time off, and a portion of her sick leave was completely unpaid.

Covid-19 Vaccines ›

Answers to Your Vaccine Questions

While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.

Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.

Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.

The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.

No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.

“I don’t want to hear what the government has to say about it — we don’t trust them anyway,” she said.

Kevin Boyd, 54, a janitor at NewYork-Presbyterian Lower Manhattan Hospital, has been offered the vaccine by his hospital but is on the fence about taking it.

On one hand, Mr. Boyd is terrified of getting sick and vividly remembers the hospital’s morgue filled to capacity last year. As a diabetic, he recognizes he is at higher risk of becoming severely ill if he is infected with the coronavirus.

On the other hand, Mr. Boyd said he was generally skeptical of the federal government and wary of the speed with which the vaccines were brought to market. “I’m kind of waiting,” he said. “I’m not rushing to take it.”

The government is not requiring people to take Covid-19 vaccines, but it has a long history of permitting such mandates. In 1905, for example, the Supreme Court upheld the right of authorities to require smallpox vaccinations. Many hospitals require some staff to get vaccinated against the flu or hepatitis B. Children must get certain vaccines to be enrolled in school.

Last month, the U.S. Equal Employment Opportunity Commission issued guidance that allowed employers to require workers to get a Covid-19 vaccine. But the guidelines also highlighted thorny legal questions that could emerge, if workers request exceptions and employers struggle to provide them with workarounds.

Few employers, though, have imposed mandates. “They’re really reluctant to get out in front of this,” said David Grabowski, a nursing home researcher at Harvard Medical School.

Another concern about forcing workers to get vaccinated is that it could prompt hesitant employees to resign. That’s a particular worry in long-term care, where the pandemic has exacerbated a shortage of certified nursing assistants.

“We’re having a hard time filling those roles and those positions now, and if we lose more people, then our old people are going to suffer,” said Dane Henning, director of public affairs at the National Association of Health Care Assistants.

Some hospitals and long-term care facilities are taking a compromise approach: offering rewards to employees who agree to get vaccinated.

Georgia-based PruittHealth, which operates about 100 nursing homes and assisted living facilities in the Southeast, said workers who got vaccinated would receive gift cards for a free breakfast at the Waffle House restaurant chain, also based in Georgia.

“If that doesn’t get you in line, I don’t know what will,” Georgia’s governor, Brian Kemp, said last month.

At Houston Methodist, a hospital system in Texas with 26,000 employees, workers who take the vaccine will be eligible for a $500 bonus. “Vaccination is not mandatory for our employees yet (but will be eventually),” Dr. Marc Boom, the hospital’s chief executive, wrote in an email to employees last month.

In an interview last week, Dr. Boom said the bonuses were “one of the many strategies to nudge people forward.” He added: “I do think we’ll get there. But I’m not naïve enough to think there aren’t people who are deeply resistant.”

At Norton Healthcare, a health system in Louisville, Ky., workers who refuse the vaccine and then catch Covid-19 will generally no longer be able to take advantage of the paid medical leave that Norton has been offering to infected employees since early in the pandemic. Instead, starting next month, unvaccinated workers will have to use their regular paid time off if they get sick with Covid-19, with limited exceptions.

Atlas Senior Living, which has 29 assisted living facilities and other communities across the Southeast, is offering workers up to four days of extra paid time off if they get vaccinated. (Some hourly workers at Atlas did not already have paid time off as part of their standard benefits.)

Atlas has sought to avoid “villainizing people that didn’t want to take it,” opting to focus on education and the reward of paid time off, said Scott Goldberg, Atlas’s co-chief executive.

Officials at Juniper and Atria said their decisions to require employees to get vaccinated were not driven by widespread hesitance among their staffs. Both chains will make exceptions for workers who are pregnant, are allergic to vaccine ingredients or have other compelling reasons to decline the vaccine.

Atria, which has about 170 assisted living facilities and other communities in 26 states, did not initially require its roughly 10,000 U.S. workers to get vaccinated; as vaccination started in its facilities last month, most took the vaccine voluntarily, said John Moore, Atria’s chief executive.

But Atria executives decided to make vaccinations compulsory anyway, concluding that it was “the responsible thing to do,” Mr. Moore said.

When Atria informed employees of the mandate last week, the response was “overwhelmingly positive,” Mr. Moore said.

At Juniper — which has 20 senior living communities in New Jersey, Pennsylvania and Colorado — officials have tried to educate workers about the safety and benefits of Covid-19 vaccines, including hosting a webinar with a registered nurse who was enrolled in a clinical trial of the Moderna vaccine. Officials told staff last month that vaccines would be mandatory.

“We didn’t know when we made this decision whether we would have large-scale numbers of people leaving, but we felt it was the right thing to do,” said Ms. Katzmann, the chief executive.

So far, 508 of Juniper’s roughly 1,500 employees have been offered the vaccine. Fifteen have resigned rather than take it.

Juliana Kim contributed reporting.

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