Covid-19 mandates boost vaccination rates among healthcare workers in California

Nurses put on personal protective equipment before tending to a Covid-19 patient inside the intensive care unit at Adventist Health in Sonora, California, on Aug 27, 2021. PHOTO: AFP

CALIFORNIA (NYTIMES) - California's requirement for all healthcare workers to be vaccinated against the coronavirus, which took effect on Thursday (Sept 30), appears to have compelled tens of thousands of unvaccinated employees to get shots in recent weeks, bolstering the case for employer mandates.

In a survey of more than a dozen of the state's major hospital systems, most healthcare employers reported vaccination rates this week of 90 per cent or higher, with hundreds - and in some cases, thousands - more workers in some systems opting to be vaccinated, rather than to apply for limited medical or religious exemptions, since Governor Gavin Newsom's administration issued the health order on Aug 5.

The uptick in vaccinations comes as a federal vaccine mandate, ordered by United States President Joe Biden, is pending for hospital and nursing home employees. Several other states also have imposed mandates for healthcare workers, including New York, where employees at hospitals and nursing homes were to have received at least one vaccine dose by the start of this week.

New York's mandate also accompanied a rise in vaccine compliance among healthcare workers, as did a mandate imposed by United Airlines, which reported this week that 99 per cent of its workforce of 67,000 was vaccinated and that 600 unvaccinated employees would be fired.

Two months after Tyson Foods mandated inoculation, 91 per cent of its 120,000 US employees are vaccinated, compared to less than half in early August.

At UC Davis Health in Sacramento, where 94 per cent of some 15,000 workers are now vaccinated, Dr David Lubarsky, the chief executive, said employee compliance was boosted both by the state mandate and an earlier one imposed in July by the University of California.

After the first mandate, he said, the system's vaccination rate, which had plateaued at about 80 per cent, rose by about 9 points, or roughly 1,350 employees. The needle then moved by another five points or so after the second mandate, adding 750 more vaccinated workers.

By contrast, Dr Lubarsky said, fewer than 1,000 employees systemwide have requested religious or medical waivers, and only about 50 are expected to be so vaccine-resistant that they will face disciplinary action and eventually lose their jobs.

Dr Lubarsky credited the shift in part to the terrifying rise of the Delta variant. Part, too, was a concerted strategy within the system to educate workers and combat misinformation. But, he said, "as deadlines loom, people tend to make decisions in their best interests".

In a recent poll by the Kaiser Family Foundation, Americans said fear of the virus's Delta variant, more than mandates, had fueled their decisions to get vaccinated.

But the California health authorities also note that the state's aggressive stance on inoculation has contributed to one of the nation's lowest rates of new coronavirus infections. About 72 per cent of eligible Californians have had at least one dose of vaccine.

Nationally, requirements for health workers to be vaccinated have prompted some nurses and other hospital employees to leave their jobs. Some have retired early, while others have resigned in protest or taken legal action.

A healthcare worker wears a mask reading "I got my Covid-19 Vaccine" in Los Angeles on Aug 11, 2021.

In California, some systems braced for disruption before the Thursday deadline as hundreds of nurses, technicians and other workers refused inoculation, but most said they were prepared to backfill staffing shortages with trainees, new hires or travel nurses.

California's statewide rules for health workers allow employees to continue working unvaccinated if they can prove that the vaccine is dangerous to their health or prohibited by their religion; they must then be tested for the virus twice weekly and wear face masks.

But medical exemptions are rare, and most major religious denominations support vaccination. Many large hospital systems also have employer mandates that are more restrictive than the state measures, and some have told workers they cannot accommodate unvaccinated employees unless they can work fully remotely.

In parts of the state that are politically conservative or that have active pockets of vaccine resistance, some hospitals reported hundreds of applications for exemptions.

A spokesman for Enloe Medical Center in rural Chico, California, which last week reported a surge of Covid-19 hospitalizations among unvaccinated patients, said this week that only about 88 per cent of the staff there is vaccinated. In another case, the health authorities said vaccine refusals had left a hospital without ultrasound technicians.

The exemption requests represent a tiny fraction of the overall health workforce, but concentrated vaccine resistance among nurses and technicians has forced some already hard-hit institutions to scramble, said Ms Jan Emerson-Shea, a spokesman for the California Hospital Association.

At Sharp HealthCare in San Diego, which employs about 18,000 workers, 91.7 per cent were vaccinated this week, up from 88 per cent two weeks ago, according to a hospital spokesman. But more than 500 employees remained unvaccinated, nearly 300 were only partly vaccinated, and nearly 700 had requested exemptions.

"It's become a real challenge for some hospitals to get enough staffing," Ms Emerson-Shea said, adding that her organisation has asked the California attorney general to investigate reports of price gouging by agencies charging hospitals hundreds of dollars an hour for travel nurses.

This week, state public health authorities offered health facilities a 45-day grace period on compliance to fill critical staff shortages caused by the mandate.

But California has generally taken a tough stance on pandemic health measures. At the start of the crisis, the state was among the first to issue stay-at-home orders, and it has been among the most aggressive in promoting masks and vaccinations.

Governor Newsom - who last month overcame a pandemic-fueled effort to remove him from office - said this week that the state is "in discussions" with school districts about a mandate requiring eligible students to get the vaccine.

State health officials this week also extended the health worker mandate to include thousands of in-home health workers and health employees at senior centers, disability centers and hospices, giving them a Nov 30 deadline.

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