Becker's Hospital Review

36 POPULATION HEALTH 36 CEO / STRATEGY How health systems are deciding whether to mandate COVID-19 vaccinations By Kelly Gooch A mid the COVID-19 vaccine rollout, U.S. hospitals and health systems are considering whether to require their employees to get shots. Some have already decided to do so. Great Falls, Mont.-based Benefis Health System said it made the vaccine mandatory for its more than 3,300 employees May 1. Employ- ees who are not exempt were required to get their second doses by July 1. Houston Methodist rolled out its mandatory vaccination policy March 31, with April 15 as the deadline for managers to receive at least one dose or get an exemption. More than 99 percent of the management team had com- plied by the deadline. By June 7, all 26,000 employees were required to have received the vaccine. What are the considerations for man- dates? One consideration is employee hesitancy or concern, addressed in a recent Washington Post-Kaiser Family Foundation poll. e poll, conducted Feb. 11 to March 7, found that 58 percent of employed healthcare workers said they would support a mandate for employ- ees who work with patients. Forty-two percent said they would oppose such a requirement. Among employed healthcare workers who don't plan to or have not decided to get vacci- nated, 65 percent said they would leave their job if they were required to get vaccinated. ere are also legal considerations. e FDA has authorized vaccines manufac- tured by Pfizer, Moderna, and Johnson & Johnson for emergency use. However, it has not given the vaccines full approval. e FDA's emergency use authorizations specify that people must consent to being vaccinated, Lawrence Gostin, a professor at Georgetown University Law Center in Wash- ington, D.C., with expertise in health law, told e Washington Post in an April 5 article. erefore, he told the newspaper, mandating a vaccine only authorized for emergency use could raise legal questions. e CDC has said the decision by employers about mandates is a matter of state or other applicable law, and if employers require proof from workers that they have been vaccinat- ed, the employer can't require the employee to provide medical information as part of the proof. e CDC said employers may imple- ment religious and medical exemptions. And the Equal Employment Opportunity Commission has released guidance on the issue. e commission told Becker's April 22 that for employers requiring vaccination as an employment condition, the Americans with Disabilities Act may require reasonable accommodation, unless there is significant difficulty or expense for the employer, for those who cannot be vaccinated because of disability. Similarly, according to the com- mission, Title VII of the Civil Rights Act of 1964 may require reasonable accommodation of employees' religious beliefs or practices re- lated to vaccines, unless the accommodation constitutes undue hardship on the employer's operations under the law. "Whether there are feasible accommodations that do not pose an undue hardship will de- pend on many facts specific to each work- place and the duties of the individual," a com- mission spokesperson said. The thought processes about mandates With these and other considerations in play, the process of deciding whether to mandate vaccination for employees remains fluid. A small number of hospitals have made the vaccine mandatory with some exceptions, such as religious exemptions, said Nancy Fos- ter, vice president of quality and patient safety policy at the American Hospital Association. However, she said most association members indicated they will decide about requiring the shot for their own workers based on safety and efficacy data available at the time the vac- cines receive full FDA approval. "All hospitals and health systems are urging their staff and the general public to take the vaccine when it is their turn as an important step to provide additional protection from the serious consequences of COVID-19, both for themselves and for others, including the patients they care for," said Ms. Foster. At Norfolk, Va.-based Sentara healthcare, a 12-hospital system with 28,300 employees, about 66 percent of staff had received at least the first vaccine dose as of April 20. Most are fully vaccinated, and the health system con- tinues to have vaccination clinics for staff. Right now, the health system has decided not to mandate the vaccine for employees, said Jordan Asher, MD, executive vice president and chief physician executive. He partially attributed the decision to the vaccines not be- ing fully approved by the FDA, although he is a supporter of vaccines. "Do I believe there are any issues [with the vaccines]? No. But I don't have the data at hand to be able to say to you as a person — let alone an employee — that I am going to man- date that you have it," said Dr. Asher. "I'm go- ing to talk about the positives. But right now, I'm finding it difficult to create a mandate. On top of that, we're in multiple states [Virginia and North Carolina]. You do have your own state regulations as it relates to labor law. You have to work through that simultaneously." As things change, though, he said Sentara continues to evaluate its decision and keep a close watch on guidance and directions from governing bodies such as the FDA. Ochsner Health, a New Orleans-based health system with more than 30,000 employees, also decided not to mandate the vaccine for employees, as long as shots are only au- thorized for emergency use. Tracey Schiro, executive vice president and chief human resources officer, said the organization could reconsider the decision aer full approval. "In speaking with our CMO about the man- datory status, we feel that until there is FDA final approval, then we will continue to evalu- ate thinking about making it mandatory," said Ms. Schiro. "Today, we do have the flu vaccine as a mandatory requirement unless someone has a medical or religious exemption, so once it's approved by FDA, I think we'll consider that and make our decision." The thought processes about incentives While Ochsner and Sentara are considering mandates, they are doing the same with in- centives. Some healthcare organizations have already announced they are offering these. St. John's Health in Jackson Hole, Wyo., for in- stance, said its board of trustees has approved a bonus program to reward employees who have been vaccinated and encourage those who haven't. To qualify, employees must have completed both vaccine doses by May 31, spokesperson Karen Connelly told Becker's. Employees will receive the bonus in June. e bonus is $600 for full-time employees and will be prorated for part-time employees. When it comes to incentives, Dr. Asher said there are various things he considers, includ- ing what the amount would be if his organiza- tion decided at some point to provide a bonus.

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