Mandates Boost Vaccination Rates Among Health Care Workers in California

·7 min read
A syringe is filled with a dose of the Pfizer-BioNTech COVID-19 vaccine at a vaccine center in Rohnert Park, Calif. on Jan. 27, 2021. (Jim Wilson/The New York Times)
A syringe is filled with a dose of the Pfizer-BioNTech COVID-19 vaccine at a vaccine center in Rohnert Park, Calif. on Jan. 27, 2021. (Jim Wilson/The New York Times)

California’s requirement for all health care workers to be vaccinated against the coronavirus, which took effect Thursday, appears to have compelled tens of thousands of unvaccinated employees to get shots in recent weeks, bolstering the case for employer mandates.

In a survey of more than a dozen of the state’s major hospital systems, most health care employers reported vaccination rates this week of 90% or higher, with hundreds — and in some cases, thousands — more workers in some systems opting to be vaccinated, rather than to apply for limited medical or religious exemptions, since Gov. Gavin Newsom’s administration issued the health order Aug. 5.

The uptick in vaccinations comes as a federal vaccine mandate, ordered by President Joe Biden, is pending for hospital and nursing home employees. Several other states also have imposed mandates for health care workers, including New York, where employees at hospitals and nursing homes were to have received at least one vaccine dose by the start of this week.

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New York’s mandate also accompanied a rise in vaccine compliance among health care workers, as did a mandate imposed by United Airlines, which reported this week that 99% of its workforce of 67,000 was vaccinated and that 600 unvaccinated employees would be fired. Two months after Tyson Foods mandated inoculation, 91% of its 120,000 U.S. employees are vaccinated, compared to less than half in early August.

At UC Davis Health in Sacramento, where 94% of some 15,000 workers are now vaccinated, Dr. David Lubarsky, the chief executive, said employee compliance was boosted both by the state mandate and an earlier one imposed in July by the University of California.

After the first mandate, he said, the system’s vaccination rate, which had plateaued at about 80%, rose by about 9 points, or roughly 1,350 employees. The needle then moved by another 5 points or so after the second mandate, adding 750 more vaccinated workers. By contrast, Lubarsky said, fewer than 1,000 employees systemwide have requested religious or medical waivers, and only about 50 are expected to be so vaccine-resistant that they will face disciplinary action and eventually lose their jobs.

Lubarsky credited the shift in part to the terrifying rise of the delta variant. Part, too, was a concerted strategy within the system to educate workers and combat misinformation. But, he said, “as deadlines loom, people tend to make decisions in their best interest.”

In a recent poll by the Kaiser Family Foundation, Americans said fear of the virus’s delta variant, more than mandates, had fueled their decisions to get vaccinated. But California health authorities also note that the state’s aggressive stance on inoculation has contributed to one of the nation’s lowest rates of new coronavirus infections. About 72% of eligible Californians have had at least one dose of vaccine.

Nationally, requirements for health workers to be vaccinated have prompted some nurses and other hospital employees to leave their jobs. Some have retired early, while others have resigned in protest or taken legal action.

In California, some systems braced for disruption before the Thursday deadline as hundreds of nurses, technicians and other workers refused inoculation, but most said they were prepared to backfill staffing shortages with trainees, new hires or travel nurses.

California’s statewide rules for health workers allow employees to continue working unvaccinated if they can prove that the vaccine is dangerous to their health or prohibited by their religion; they must then be tested for the virus twice weekly and wear face masks.

But medical exemptions are rare, and most major religious denominations support vaccination. Many large hospital systems also have employer mandates that are more restrictive than the state measures, and some have told workers they cannot accommodate unvaccinated employees unless they can work fully remotely.

In parts of the state that are politically conservative or that have active pockets of vaccine resistance, some hospitals reported hundreds of applications for exemptions. A spokesperson for Enloe Medical Center in rural Chico, California, which last week reported a surge of COVID-19 hospitalizations among unvaccinated patients, said this week that only about 88% of the staff there is vaccinated. In another case, health authorities said vaccine refusals had left a hospital without ultrasound technicians.

The exemption requests represent a tiny fraction of the overall health workforce, but concentrated vaccine resistance among nurses and technicians has forced some already hard-hit institutions to scramble, said Jan Emerson-Shea, a spokesperson for the California Hospital Association.

At Sharp HealthCare in San Diego, which employs about 18,000 workers, 91.7% were vaccinated this week, up from 88% two weeks ago, according to a hospital spokesperson. But more than 500 employees remained unvaccinated, nearly 300 were only partly vaccinated, and nearly 700 had requested exemptions.

“It’s become a real challenge for some hospitals to get enough staffing,” Emerson-Shea said, adding that her organization has asked the California attorney general to investigate reports of price gouging by agencies charging hospitals hundreds of dollars an hour for travel nurses.

This week, state public health authorities offered health facilities a 45-day grace period on compliance to fill critical staff shortages caused by the mandate.

But California has generally taken a tough stance on pandemic health measures. At the start of the crisis, the state was among the first to issue stay-at-home orders, and it has been among the most aggressive in promoting masks and vaccinations.

Newsom — who earlier this month overcame a pandemic-fueled effort to remove him from office — said this week that the state is “in discussions” with school districts about a mandate requiring eligible students to get the vaccine. State health officials this week also extended the health worker mandate to include thousands of in-home health workers and health employees at senior centers, disability centers and hospices, giving them a Nov. 30 deadline.

“This is a critically important mandate that helps ensure the safety of all individuals in our health care system, and it especially protects those who are critically ill who rely on hospitals and other facilities to protect their health,” Dr. Tomás J. Aragón, the state’s public health director, said in a statement, adding that health authorities are watching deadlines closely and “expect full compliance.”

Compliance appears to be the aim at the state’s largest health care employers. At the massive Kaiser Permanente system, for example, more than 9 in 10 of the 216,000 employees and 23,000 physicians in California are fully vaccinated, a spokesperson for the system said. Two weeks ago, the system’s employee vaccination rate was about 87%.

At Cedars-Sinai Medical Center in Los Angeles, about 97% of 17,000 or so employees are now vaccinated. Dr. Jeffrey A. Smith, the chief operating officer, said that while most of the hospital’s staff and physicians were early adopters, as many as 800 employees got their shots after the state mandate limited their options to work at other California hospitals.

Similarly high compliance rates were reported by Stanford Health Care in Palo Alto, where officials said 97% of 15,000 workers were now vaccinated; at the sprawling Northern California system Sutter Health, where some 91% of employees and 96% of affiliated providers are now vaccinated, representing more than 54,000 health care workers; at St. Agnes Medical Center in Fresno, where more than 90% of some 3,600 physicians and staff are vaccinated; and at UC Irvine Health in Orange County, where officials said the university and state mandates have boosted vaccination rates among nurses to 95%.

“We don’t do this because we want to force health care workers to get vaccinated; we do it because patients deserve protection,” said Sen. Richard Pan, a state legislator and pediatrician who led a push in recent years to tighten California’s vaccine laws.

“If you’re in health care because you’re committed to taking care of people, then getting vaccinated is a pretty straightforward decision,” Pan added. “If we stand firm, I think most people will step up.”

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