The nation’s leading infectious disease groups have issued a joint paper recommending COVID-19 vaccination as a condition of employment for healthcare workers, with limited exemptions.1

The broad consensus adds considerable momentum to the mandate movement, and now it may be only a matter of time before universal COVID-19 immunization of employees will be the standard across healthcare.

This consensus statement was issued by the Society for Healthcare Epidemiology of America (SHEA), the Society for Post-Acute and Long-Term Care Medicine (AMDA), the Association for Professionals in Infection Control and Epidemiology (APIC), the HIV Medicine Association (HIVMA), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP).

“The bottom line is that we, as a group of societies, feel that this is the right thing to do for our communities, patients, and healthcare providers,” lead author David Webber, MD, said at a press conference. “We have a precedent for doing this for other [occupational] diseases. We believe the benefits of the vaccine for our healthcare providers far outweigh any possible harm, and we strongly endorse this statement.”

As has been seen with seasonal flu shots, optimal vaccination rates are unlikely to be reached without making immunization a condition of work, the paper observed.

Delta Variant Concerns

Representing SHEA, Webber said the rapidly emerging Delta variant of SARS-CoV-2 also underscores the importance of vaccinating healthcare workers and the public in general.

“It is much more transmissible and has a higher risk of hospitalization,” he said. “The most rapid spread is occurring in those states with the highest percentage of unvaccinated people. There [are] good data that the mRNA vaccines continue to provide protection against hospitalizations, but a little less protection against illness. This is the time to be pushing vaccination to the general public and our healthcare providers as well.”

The group did not specify the methods of establishing mandatory programs, but said it was time to start outlining COVID-19 vaccination requirements, while both talking and listening to healthcare workers.

Healthcare leaders must consider both requiring the vaccine and how to operate the policy. “Approach this process in a respectful, thoughtful, and inclusive manner and apply the principles of diversity, equity, and inclusion,” said Rekha Murthy, MD, a member of the SHEA board.

On the legal questions of mandating a vaccine that is approved under Emergency Use Authorization, the consensus paper states, “an individual has a right to refuse vaccination, but has no right to a particular job.” We still are early in the process, but this “condition of work” approach has been approved in at least one court ruling. A key is allowing for specific exemptions to vaccination for medical and religious reasons.

“A medical exemption is based on contraindications and precautions set forth by the manufacturer or CDC (Centers for Disease Control and Prevention) and usually requires review and signature by a medical professional,” the consensus paper states. “ … While not a contraindication, healthcare facilities may wish to allow pregnant [healthcare workers] to postpone receipt of the vaccine until post-delivery. …Pregnant and lactating HCP (healthcare personnel) should be allowed to receive a vaccine because, as noted by the CDC, ‘pregnant and recently pregnant people are more likely to get severely ill from COVID-19 compared to non-pregnant people.’”

For religious exemption requests, employers could use a form allowing objectors to detail their sincerely held beliefs and practices, the panel suggested. “While affiliation with a traditionally organized religion may be evidence to support a claim of a sincerely held religious belief, the lack of such an affiliation cannot be the basis for rejecting an exemption request,” the consensus paper states.

Benefits and Boosters

Full vaccination against COVID-19 confers several advantages to healthcare workers, including self-protection and preventing transmission to patients and coworkers who may be contraindicated for the vaccine or less immune responsive. Another key benefit — perhaps the most persuasive to healthcare workers — is that vaccination can protect the family members they come home to. The consensus statement also supports COVID-19 vaccination of non-employees in a healthcare facility, such as students, contract workers, and volunteers.

“Given the short duration of immunity to seasonal coronaviruses after infection and the speed with which disparate viral variants with mutated spike proteins are emerging, at some point in the future, a booster may be required for waning immunity and/or improved coverage for emerging variants,” the authors note.

Similarly, it important to specify that persons who have had COVID-19 should still be vaccinated. If a healthcare facility decides that a mandatory policy is not possible at the present time, it should ensure healthcare workers continue to be educated about the vaccine and be given convenient opportunities to get immunized at no personal cost, the panel noted.

“If minimal adequate coverage (e.g., greater than 90% based on minimum influenza vaccination rates) is not achieved within a reasonable time period (e.g., one to three months), the facility should implement a policy of requiring COVID-19 vaccination as a condition of employment,” the paper concludes.

REFERENCE

  1. Weber DJ, Al-Tawfiq J, Babcock H, et al. Multisociety statement on COVID-19 vaccination as a condition of employment for healthcare personnel. ICHE. Cambridge University Press. Published July 13, 2021. https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/multisociety-statement-on-covid19-vaccination-as-a-condition-of-employment-for-healthcare-personnel/690D1804B72FFF89C5FC0AED0043AD62