Too Many HCWs Not Vaccinated for COVID-19
Rates are incrementally climbing, federal mandate in limbo
Even as a federal mandate to vaccinate healthcare workers against COVID-19 is facing court challenges, a new analysis finds that immunization of medical personnel stalled out in fall 2021 and only now may be improving incrementally, researchers at the Centers for Disease Control and Prevention (CDC) report.1
“Among the hospital-based healthcare personnel (HCP) included in this analysis, COVID-19 vaccine coverage increased steadily between the time of vaccine introduction (December 2020) and April 2021,” the researchers reported. “But the rate of uptake has slowed, and a substantial proportion of HCP remain unvaccinated. As of Sept. 15, 2021, among 3.3 million in HCP in 2,086 facilities included in this analysis, 70% were fully vaccinated.”
Surveys conducted to understand factors driving vaccine hesitancy rounded up the usual suspects, including adverse effects and the speed of vaccine development.
“HCP who did not want to be vaccinated often reported low trust in regulatory authorities and the government,” the CDC authors found. “Notably, trust in information received from medical professionals was higher, suggesting an important role of professional societies and medical organizations in enhancing vaccine uptake among HCP and combating misinformation.”
Successful mandates for influenza vaccination at many hospitals provide a good example of how much the situation can be improved with requirements. “[Mandates led to] high influenza vaccination rates and a significant decrease in HCP absenteeism, healthcare-associated influenza among hospitalized patients, and patient mortality,” they reported. “In 2019-2020, 81% of HCP received influenza vaccine, with higher coverage among [those] who were required by their employer to be vaccinated (94%) than those whose employer did not require vaccination (70%).”
The CDC researchers reviewed data voluntarily reported to the Health and Human Services Unified Hospital Data Surveillance System to assess COVID-19 vaccination status among hospital-based workers from Jan. 20, 2021, to Sept. 15, 2021. The highest employee vaccination rates were pediatric hospitals (77%), short-term acute care (70%), and long-term acute care hospitals (69%) and critical access hospitals (64%). Healthcare workers in metropolitan counties had the higher vaccination rates (71%) than those in rural counties (65.%) and non-metropolitan rural counties (63%).
Lead author Hannah Reses, MPH, an epidemiologist in the CDC Division of Healthcare Quality Promotion, answered the following questions from Hospital Infection Control & Prevention (HIC) via email.
HIC: Do you have any data or anecdotal information that the incremental increases you observed are continuing and the percentage of vaccinated healthcare workers now may be higher?
Reses: We recently re-analyzed the data and observed that as of Nov. 17, 2021, 39% of hospitals reported data and passed quality checks. Among these hospitals, 75% of the healthcare personnel were fully vaccinated. This trend is consistent with the incremental increases we had observed through September.
However, this result should be interpreted with caution, as we don’t know whether the facilities not reporting would have higher or lower vaccination coverage among their healthcare personnel. The CMS (Centers for Medicare and Medicaid Services) Omnibus COVID-19 Health Care Staff Vaccination interim final rule requires that all eligible staff working at most CMS-certified facilities receive complete COVID-19 vaccination by early January 2022, and we anticipate that this should substantially increase COVID-19 vaccine coverage among hospital-based healthcare personnel.
HIC: You noted that “this increased rate of uptake may be a response to increased COVID-19 rates due to the delta variant or related to mandates implemented in some jurisdictions.” Would you expect healthcare vaccination rates to go up similarly if omicron or some other variant shows higher transmission ability than delta?
Reses: It is possible that the emergence of a new, highly transmissible variant could lead to increased awareness and concern about COVID-19, thereby leading to increases in vaccine uptake among healthcare personnel.
HIC: Will it take mandates to raise the number of vaccinated workers in long-term care, a historical laggard in this area?
Reses: The CDC National Healthcare Safety Network (NHSN) collects weekly COVID-19 vaccination data for residents and healthcare personnel in all CMS-certified skilled nursing facilities in the United States.
Currently, about 78% of staff in these facilities are fully vaccinated, and increases in COVID-19 vaccine coverage among skilled nursing facility staff have been observed in recent months; this increase may be partially in response to state-level vaccination mandates and the CMS Omnibus COVID-19 Health Care Staff Vaccination interim final rule, which requires that all eligible staff working at most CMS-certified skilled nursing facilities receive complete COVID-19 vaccination by early January 2022.
- Reses HE, Jones ES, Richardson, DB, et al. COVID-19 vaccination coverage among hospital-based healthcare personnel reported through the Department of Health and Human Services Unified Hospital Data Surveillance System, United States, January 20, 2021-September 15, 2021. Am J Infect Control 2021;49:1554-1557.
Even as a federal mandate to vaccinate healthcare workers against COVID-19 is facing court challenges, a new analysis revealed immunization of medical personnel stalled in fall 2021 and only now may be improving incrementally.
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