Skip to main content

All Access Subscription

Get unlimited access to our full publication and article library.

Get Access Now

Interested in Group Sales? Learn more

HI Cprevent logo small


This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Mandating COVID-19 Vaccines for Healthcare Workers Has Begun

By Gary Evans, Medical Writer

Houston Methodist Hospital is one of the first institutions in the nation to mandate COVID-19 vaccines for healthcare workers and other employees. Many see such mandates as the wave of the future, but others advise caution and patient messaging to let staff make a willing choice about a controversial vaccine.

Houston Methodist mandated seasonal vaccines in 2009 with limited medical and religious exceptions. The current annual vaccination rate for flu is 99.3% at the healthcare system.

“We were one of the first hospital systems to mandate the flu vaccines,” says Carole Hackett, senior vice president of human resources at Houston Methodist. “We started thinking about when a COVID vaccine might be available in June of 2020. We had to make sure of the efficacy and safety, and issues like supply vs. demand. [But with these caveats], we announced at some point that it would be mandatory.”

In March 2021, executives took the first vaccines, followed by management employees. By the end of March, about 85% of the entire staff was vaccinated, and new hires were being immunized as a condition of employment.

“Our policy states if you don’t get the vaccine you will be suspended for two weeks,” she says. “Hopefully during that two weeks, we can answer questions and dispel any myths to make sure that people have accurate information to make the right decision — the decision that they choose to make. We respect everyone’s choice. We hope they choose to get the vaccine, but we understand that some will not.”

On April 16, 2021, the hospital system announced that all employees must be fully immunized by June 7. Overall, the Methodist healthcare system has some 26,000 employees, she says. As of May 18, 97% of hospital employees have been immunized with at least the first shot of one of the mRNA two-shot vaccines or submitted an exemption.

“People have been allowed to submit for medical and religious exemptions,” she says. “We have also allowed — since the clinical trials didn’t have any pregnant women in them — all of our pregnant employees to have a choice to defer the vaccine. They do not have to receive the vaccine until they deliver and come back into the organization.”

The hospital is also sensitive to healthcare workers on fertility medications, allowing deferment until treatment is over. “Also, another group to defer is those people who got COVID and received monoclonal antibodies,” Hackett says. “You cannot receive the vaccine until three months after you have had that infusion.”

Those who submit a religious deferment must name the religious authority that supports their action. “It doesn’t have to be clergy or a church setting,” she says. “It has to be somebody who knows this person and can be their religious authority.”

Some healthcare systems have decided not to mandate SARS-CoV-2 immunization until the Food and Drug Administration lifts the emergency use authorization (EUA) for the COVID-19 vaccines approved in the United States. Hackett says that Houston Methodist uses a thorough and expert review process to mandate any vaccine and will continue to follow new developments, like the need for boosters or seasonal shots.

“We have a committee of our scientists and physicians to help guide us.” Hackett says. “All of our decisions are based on science. Our legal advice was, as long as we had offered accommodations — religious and/or medical exemptions — mandating the vaccine is legal even under EUA. As a healthcare organization, we have to keep our patients safe and not spread this disease.”

Connie Steed, MSN, RN, CIC, director of infection prevention and control at Prisma Health in Greenville, SC, sees more mandatory vaccination policies in hospitals as inevitable.

“When we are able to require COVID vaccinations, [our immunization rates will go up],” she says. “Some hospitals have done that — but many haven’t because it is still under EUA. But I think it will go that way. We have mandatory flu vaccination. We couldn’t get it above 60%, and we are now we are at 99.6% immunized in a 12-hospital organization. Mandatory is the only way to get it up to speed.”

The EUA designation was expected to be dropped first for the Pfizer vaccine, says William Schaffner, a nationally known vaccine expert at Vanderbilt University in Nashville. Still, he is somewhat skeptical of widespread mandated COVID-19 vaccinations in healthcare thereafter.

“Pfizer has put through its biological license application,” Schaffner says. “The anticipation is that will move rather smoothly through the process, so that [EUA] barrier will probably be removed. But this is still a new, and in many ways a controversial, vaccine. I would be surprised if very many institutions move to make it mandatory right away.”

For more on this story, see the next issue of Hospital Employee Health.

Gary Evans, BA, MA, has written numerous articles on infectious disease threats to both patients and healthcare workers. These include stories on the original SARS, SARS-CoV-2, pandemic influenza, MERS, and Ebola. He has been honored for excellence in analytical reporting in newsletter journalism five times by the National Press Club in Washington, DC.