Vaccine fatigue at work: Only 8% of Iowa nursing home workers have up-to-date COVID shots

COVID-19 vaccination rates among Iowa's nursing homes are significantly lagging this year, highlighting the toll that vaccine fatigue is taking on front-line health care workers as the respiratory virus season nears.

Only 8% of nursing home staff statewide are up to date on their coronavirus shots as of Nov. 26, the latest data available from the U.S. Centers for Disease Control and Prevention.

And only 45% of Iowa's nursing home residents are up to date on COVID-19 vaccines, according to the CDC. While that's better than the national average of 27%, it still trails rates from previous years.

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Vaccine access is no longer the problem. The new federal data comes several weeks after long-term care facilities have smoothed out the bumps from the initial rollout, and vaccine appointments are readily available in pharmacies and clinics in Iowa.

But the sliding rates do come after the federal government lifted its mandate for nursing home staff to be vaccinated.

The result is that Iowa's nursing home workers simply aren't seeking out the new COVID-19 shots at rates industry officials and other public health experts had hoped for.

“That all ties into what we call vaccine fatigue,” said Madisun VanGundy, public health communications officer at the Polk County Health Department. “People are tired of hearing about COVID. They want to get back to their lives and forget it happened.”

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Why are nursing home workers experiencing vaccine fatigue? The reasons vary.

Since the new vaccines arrived several weeks ago, Kim Bergen-Jackson, administrator for Oaknoll Retirement Community in Iowa City, has been working to get her residents and staff vaccinated by hosting vaccine clinics or encouraging them to schedule their own appointments elsewhere.

Residents have embraced that message, and now more than 90% of the campus' approximately 480 residents are up to date on their vaccines, Bergen-Jackson said.

But among the total 320 staff members, only 50 have received the new COVID-19 shots.

The divide frustrates Bergen-Jackson, who said she has struggled to raise the vaccination rate among her staff.

“I absolutely don't want to have an outbreak," she said. "I don't want anybody to die. I’ll keep singing the praises of the benefits of vaccination, but I’m not sure anybody’s listening anymore.”

Nursing home officials say the main cause is vaccine fatigue, a phenomenon defined by the American Medical Association as an unwillingness or lack of drive toward a vaccine due to perceived burden or burnout.

Workers may not be seeking out shots because of a perceived inconvenience of time, or because they want to avoid the short-term symptoms often associated with the shots.

Another likely driving factor among workers, according to some nursing home officials, is confusion over the frequency of COVID-19 boosters and vaccines over the past three years.

That has led some staff to question the necessity of getting another shot this fall, especially after they've already received a handful of boosters in recent years, said Crystal Scroggin, administrator of Spurgeon Manor nursing home in Dallas Center.

“We’ve noticed with every additional dose, it’s a little bit harder to get people to want to go get another one," she said.

Vaccine fatigue for some may also tie back to their mental health, VanGundy said. Front-line health care workers are the individuals who saw firsthand the worst outcomes of the pandemic, which killed more than 10,000 Iowans between March 2020, when the first infection was reported, and late 2022.

“COVID was a hard time for a lot of people," VanGundy said. "We’re seeing that a lot of people in the health care industry — and people in the community in general — have PTSD from the pandemic. So it’s hard to still hear about COVID, because it reminds them of the difficult times we all experienced during the pandemic."

If reduced vaccination rates lead to COVID infections, how will nursing homes address spread?

The slow uptick in vaccination rates among nursing home workers has alarmed officials, who have raised concerns that low vaccine protection could lead to increased risk of spread of illness within these facilities.

Nursing home residents are vulnerable to severe disease from coronavirus infections, along with other respiratory viruses.

“We’ve seen what’s at risk. We saw this years ago, which was outbreaks in nursing homes, leading to tragic consequences with nursing home residents," said Brad Anderson, AARP Iowa's state director. "The last thing that anyone wants to see (is) nursing home outbreaks leading to lockdowns, leading to social isolation, and leading to residents dying. We just simply cannot afford to go through that again.”

New COVID-19 cases have been on the rise in recent weeks, with state public health officials reporting an 18% positivity rate for coronavirus tests as of the week of Nov. 25.

However, that total does not offer a full picture of coronavirus activity in Iowa, given the widespread availability of at-home tests that aren't reported to state officials.

Statewide, 6.6% of residents are up to date on COVID-19 vaccinations as of earlier this month, according to data from the Iowa Department of Health and Human Services.

Because of current vaccine rates, long-term care facilities will likely rely heavily on other mitigation strategies.

Bergen-Jackson of Oaknoll in Iowa City said she is requiring staff and residents to mask if they are experiencing any respiratory symptoms. She is also testing within her facility frequently, and isolating any residents who come back positive for coronavirus. Staff who are sick are highly encouraged to stay home from work, she said.

Scroggin, the administrator of Spurgeon Manor, said the facility also plans to rely on a masking policy to reduce spread of illness.

Still, even with less protection from vaccination, the panic from the early days of the pandemic over a positive coronavirus test is gone among some nursing home officials. Scroggin said more residents and staff have some immunity from previous infection or vaccination, helping reduce the risk for hospitalization and death from a serious illness.

“I think we just know so much more now to protect them," she said. "And with treatments available now too, we’re just so much better equipped to handle someone getting sick.”

Michaela Ramm covers health care for the Des Moines Register. She can be reached at mramm@registermedia.com, at (319) 339-7354 or on Twitter at @Michaela_Ramm

This article originally appeared on Des Moines Register: Most Iowa nursing home staff are skipping COVID shots so far in 2023