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Enough pleas: Hospitals must mandate vaccines now

"At this stage of this pandemic, hospitals are more than ethically justified in requiring health care personnel to get vaccinated."

Credit where credit is due. First, to Springfield’s Baystate Health, which announced this week it will require all staff to be vaccinated against COVID-19 effective October 1. Ditto for St. Peter’s Health Partners, which set a September 21 deadline for its Capital Region employees. (A brilliant stroke by parent company Trinity Health of Michigan, knowing September 21 is the 40th anniversary of the International Day of Peace.) And lots of love to Dana-Farber Cancer Institute, which changed course on Friday. Instead of waiting for full FDA approval of emergency use vaccines, which was its original plan, this specialty hospital set October 1 as the deadline for employee vaccination, given rising COVID cases. My sincerest thanks to the physician leaders of these three strong community assets: Dr. Mark A. Keroack, Dr. James Reed, and Dr. Laurie H. Glimcher. Kudos to you all.

The kind of clarity we need now from our medical centers is simple to understand because the Delta variant is here, hospitals must ensure patient safety, and customer priorities dictate health. Voila! As Secretary of Veterans Affairs Denis McDonough said, explaining his decision to require 115,000 of its frontline health care workers to get vaccinated in the next eight weeks, “I am doing this because it’s the best way to keep our veterans safe, full stop.” Amen.

It is an ironic twist of fate that Operation Warp Speed has crashed into the laggards among us. If only the initial messaging about the disruptive innovation of mRNA vaccines had been louder, perhaps we’d have reached herd immunity already. But we can no longer afford to rely solely on vaccine whisperers and genteel pleas to turn the ship around. While vaccine laggards aren’t necessarily suicidal, more than 99 percent of recent deaths were among the unvaccinated. Obviously, you can’t be part of the late majority of shot takers if you die first.

It is no wonder then that hospital vaccine mandates have become urgent matters, no longer merely important ones. Indeed, health care professional societies have spoken. To wit, the American Medical Association, American Nurses Association, American Academy of Pediatrics, Association of American Medical Colleges, and National Association for Home Care and Hospice were among more than 50 organizations that released a joint statement last week calling for all employees to be vaccinated against COVID-19.

True, this past week’s COVID-19 cases at a Berkshire health care facility in North Adams, like the Provincetown outbreak, affected mainly those who were vaccinated. But these represent two highly vaccinated populations to begin with: a skilled nursing facility with a resident vaccination rate of 89 percent and a gay mecca with a vaccination rate arguably as high as 114 percent. In each scenario, few hospitalizations resulted. As mathematician Aubrey Clayton suggests, the best way to think about vaccine effectiveness is to ask what proportion of vaccinated people wind up in the hospital, not what proportion of hospitalized people were vaccinated.

At this stage of this pandemic, hospitals are more than ethically justified in requiring health care personnel to get vaccinated. What’s more, Virginia Mason Medical Center’s overall success in mandating the flu vaccine offers a blueprint for vaccination mandates. Its list of other medical firsts is truly impressive. No wonder US News & World Report ranks Virginia Mason so highly among Seattle area hospitals.

Unfortunately, Berkshire Health Systems hasn’t announced a COVID-19 vaccine mandate yet. With roughly 20 percent of its staff unvaccinated, this is significant in terms of both individual and community health. An email from the Massachusetts Nurses Association (MNA), the state’s largest union of registered nurses, noted, “Our position has been that we have encouraged our members to get the vaccine, and we believe the vast majority have already done so. We do not support mandating a vaccine that is still under emergency use authority, and we are glad to see the industry agrees and will not mandate the vaccine while under emergency designation.” In a phone call this morning with MNA’s Associate Director of Public Communications Joe Markman, he characterized the Association’s approach as “nuanced.”

As I wrote this column Saturday afternoon, the COVID-19 epicenter swung back to Florida. That afternoon, the Miami Herald’s editorial board endorsed hospital vaccine mandates as well, leading with the obvious: “Healthcare workers shouldn’t make patients sick.” It’s validating when both a major newspaper’s entire editorial board and you write basically the same thing at the same time. NB: the Herald’s is an all-female editorial board.

In yesterday’s edition of the Miami Herald, reporter Daniel Chang offered a master class in why hospital vaccine mandates are coming. Spoiler alert: infection is not nuanced. One either has a particular infection or one does not. And hospitals can only maintain their strategic edge through legitimate quality efforts. If inoculating their workforce isn’t yet required, this speaks volumes about their organizational leadership — and lack thereof.

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