With the delta variant now causing 80% of COVID-19 cases in the United States, vaccine mandates for healthcare workers have become a foregone conclusion. At a recent press conference, the CDC recommended the vaccinated return to wearing masks indoors because of the variant.

First seen in India, delta represents several iterations of viral evolution and is much more transmissible and possibly more virulent than the original SARS-CoV-2. Some treatments are not as effective against the strain, but the vaccines generally are efficacious, with some expected breakthrough infections. The hospital and death numbers are astounding among the unvaccinated, who are causing another surge, even though more than half the nation is vaccinated.

As has been said of highly transmissible measles, an airborne infectious virus can hit a susceptible population like a lit match on a tinder box. “We’re mandating vaccines for [Veterans Health Facility] employees because it’s the best way to keep veterans safe, especially as the delta variant spreads across the country,” Denis McDonough, secretary of the department of Veterans Affairs, said in a July 26 statement.1

Recently, four unvaccinated VA employees died from the delta variant. “There has also been an outbreak among unvaccinated employees and trainees at a VA Law Enforcement Training Center, the third such outbreak during the pandemic,” McDonough noted.

A law professor at Georgetown University (who predicted lawsuits against hospitals mandating the COVID-19 vaccine would fail) says it is time to move ahead with healthcare worker immunizations as a condition of employment. “Vaccine mandates in hospitals and for other businesses are entirely lawful and ethical, even under an emergency use authorization,” says Lawrence Gostin, JD.

Of course, hospitals have long required vaccines for many diseases because healthcare workers have a “special responsibility” to protect staff and patients, he notes. Mandates have shown to significantly increase vaccination coverage.

“As COVID is spiking again, it is time for most hospitals to require vaccinations,” Gostin says. “Most infectious disease experts and organizations have called for mandates. They are urgent, and we shouldn’t wait until full FDA licensure.”

Indeed, it is becoming difficult to find a major medical group that is not calling for mandates, with the American College of Surgeons, the American Medical Association, American Nursing Association, and the American Academy of Pediatrics recently joining the chorus.

These prestigious organizations were among more than 50 signatories to a joint letter calling “for all healthcare and long-term care employers to require their employees to be vaccinated against COVID-19. We stand with the growing number of experts and institutions that support the requirement for universal vaccination of health workers.”2

The nation’s leading infectious disease groups issued a joint paper recommending COVID-19 vaccination as a condition of employment for healthcare workers, with limited exemptions.3 The broad consensus adds considerable momentum to the mandate movement. It appears to be only a matter of time before universal COVID-19 immunization of employees will be the standard across healthcare, particularly if the FDA lifts the emergency use authorization on the vaccines, as expected.

This consensus statement was issued by the Society for Healthcare Epidemiology of America, the Society for Post-Acute and Long-Term Care Medicine, the Association for Professionals in Infection Control and Epidemiology, the HIV Medicine Association, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists.

“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,” statement lead author David Weber, 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.”

Weber also said the rapidly emerging delta variant underscores the importance of vaccinating healthcare workers and the public.

“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 is time to start outlining COVID-19 vaccination requirements while both talking and listening to healthcare workers.

On the legal questions of mandating a vaccine that is approved under emergency use, “an individual has a right to refuse vaccination, but has no right to a particular job,” the statement authors noted. “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 and usually requires review and signature by a medical professional. 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.’”3

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.”

REFERENCES

  1. U.S. Department of Veterans Affairs. VA mandates COVID-19 vaccines among its medical employees including VHA facilities staff. July 26, 2021.
  2. Academy of Managed Care Pharmacy, American Academy of Ambulatory Care Nursing, American Academy of Child and Adolescent Psychiatry, et al. Joint statement in support of COVID-19 vaccine mandates for all workers in health and long-term care. July 26, 2021.
  3. Weber DJ, Al-Tawfiq J, Babcock H, et al. Multisociety statement on COVID-19 vaccination as a condition of employment for healthcare personnel. Infect Control Hosp Epidemiol 2021;1-46.