Undeterred by a few protests, hospitals are increasingly requiring employees to get vaccinated for COVID-19

The largest health care system in Indiana has emerged as the second U.S. hospital group facing pushback for requiring COVID-19 vaccines for all employees, despite a federal judge tossing out a lawsuit filed by resistant Houston hospital workers.

Hundreds of employees demonstrated outside one of the IU Health hospitals on a recent Saturday afternoon, and another protest is planned for July 11.

Houston Methodist hospital system also remains in the national spotlight for forcing out 153 employees this week who refused to get vaccinated.

The nurse who led the opposition, Jennifer Bridges, appeared on Fox News’ "Hannity" Tuesday night. Her attorney vowed to take the case all the way to the Supreme Court, and another protest was scheduled at the downtown Houston hospital Saturday. This time, InfoWars’ controversial host Alex Jones has told organizers he plans to attend.

Yet across the country, little fanfare has greeted the dozens of hospitals that have quietly begun following Houston Methodist’s lead. Many predict that if the FDA gives full approval to the Pfizer and Moderna vaccines soon, as expected, there could be a tsunami of hospitals signing on.

Some of the most prestigious hospitals in the nation have joined the trend, including Johns Hopkins Hospital, New York-Presbyterian, Mass General Brigham and the Hospital of the University of Pennsylvania. Meanwhile, nearly all hospitals in Washington, D.C., Maryland and Connecticut have announced plans to require vaccines.

One difference is that while Houston Methodist and IU Health both made terminations the consequence of refusing to get vaccinated, other hospitals are taking a softer approach. Maryland hospitals, led by the University of Maryland’s 13 hospitals and Johns Hopkins’ four hospitals, will require employees to be vaccinated by Sept. 1. Unlike at Houston Methodist, there was no talk at this point of firing workers.

“There's not a sanction for noncompliance with the vaccine requirement,” said Bob Atlas, president and CEO of the Maryland Hospital Association. “Anybody who's not vaccinated will be required to get COVID tests.”

Atlas said that could change in Maryland, however.

Jacqueline D. Bowens, president and CEO of the District of Columbia Hospital Association, said the city’s 13 hospitals were not faced with local politicians or public sentiment hostile to the vaccines, which made the decision easier. Still, the hospitals discussed easing in the mandate over time.

“We want to be not focused on being punitive, but how do we educate and engage our staff around what this looks like,” Bowens said. “So, we're going to take our time.”

Each hospital has its own rules. UofL Health, a hospital system based in Louisville, Kentucky, has set a Sept. 1 deadline for vaccines, but a spokesperson said the date could be pushed back if the FDA has not fully approved any vaccines by then.

The FDA has authorized the Moderna, Pfizer and Johnson & Johnson vaccines under a special emergency provision. The Houston lawsuit claimed that federal law prohibits employers from requiring vaccines without full approval, an assertion U.S. District Judge Lynn Hughes said does not apply to private employers.

This is not the first time hospitals have required vaccines. Over the past decade or so, many hospitals began requiring workers to get an annual flu vaccine. For some, it is a condition of employment. For others, refusal means a worker must wear masks and protective gear during flu season.

Hospital administrators say requiring a COVID-19 vaccine has been more controversial, leaving some of them sensitive to concerns about the vaccines still being relatively new. Others disagree with that stance.

“It is counterintuitive that we would mandate the flu vaccine and not mandate the SARS-CoV-2 vaccine,” said Dr. Patrick Brennan, chief medical officer of the University of Pennsylvania Health System. “I think it speaks to the state of affairs in the country, frankly. I think there’s a lot of concern about these strongly held beliefs that are oftentimes misinformed.”

Arthur Caplan, a bioethicist at NYU Langone Health, said he expects hospitals ultimately to take the same path as they did with flu vaccines. In a health care setting, patients come first, he said.

“If you’re really vaccine-hesitant, really worried about the vaccines,” Caplan said, “you’re probably a bad role model, and you probably should get another job.”

New York-Presbyterian, which has 16 hospitals and medical centers, decided to require the vaccine after watching the number of workers vaccinated remain flat at 70% for several months.

“We decided that the time was right to move forward,” said Dr. Laura Forese, the system’s chief operating officer. “Not everyone agrees, but we are getting a lot of support from the many team members who have already been vaccinated and, most importantly, from our patients who are asking every day about vaccinations. They wanted it for themselves. They want it for the people they're going to interact with on our health care team.”

Forese said she was pleased but not surprised to see the judge dismiss the Houston Methodist lawsuit. Hughes rejected the notion that the vaccines were experimental or that workers were being coerced into getting the shots. He said the simple answer was to find another job. Lead plaintiff Bridges, herself, said she has already starting working for a private health care company.

Most hospitals contacted by USA TODAY said their position has been met with no organized protests or lawsuits. One exception was IU Health, which includes18 hospitals and 11 urgent care clinics and is separate from Indiana University.

IU Health set a Sept. 1 deadline to be fully vaccinated. Currently, 64% of the staff are vaccinated, and refusing to comply can cost employees their jobs.

Traci Staley, an office worker who organized the protests, administers a new, private Facebook group called Indiana Against the Mandate, with 7,600 members.

“I have (had my) mind blown by just how many employees are against this,” she said. “Our group has grown beyond just IU Health to include other hospitals and health care facilities, and people from all across the state in various professions.”

She said the hospitals have scheduled listening sessions with doctors, which in her opinion have not been persuasive.

“They have truly shown just how much they do not value their employees or care about their differences,” she said. “It doesn’t matter if you’ve been here five years or 35 years; they tell you if you won’t comply, this isn’t the place for you.”

The crucial factor for hospitals is that they treat vulnerable patients, said Nancy Foster, a vice president at the American Hospital Association.

“A health care worker who doesn't even know they are sick, because they're not experiencing symptoms, could spread the disease to a vulnerable patient whose immune system may be compromised either by their disease or by some of the treatments that we're administering,” Foster said.

The association supports flu vaccine mandates but hasn’t yet taken a position on COVID-19 vaccines.

David Heath is a reporter on the USA TODAY national investigations team. Contact him at dheath@usatoday.com or @davidhth, or on Signal at (240) 630-1962.

This article originally appeared on USA TODAY: Vaccine requirements for COVID-19 are taking hold at hospitals