Viewpoint: COVID-19 vaccines should be a condition of employment for healthcare personnel

This week, a national coalition of epidemiology, infection prevention, infectious diseases, pharmacy, and legal experts from medical societies representing more than 30,000 healthcare professionals concluded that hospitals, health systems and places where healthcare is delivered should make COVID-19 vaccination a condition of employment, permitting exemptions only for those with medical contraindications and to comply with federal and state laws.

The recommendation was reached following an eight-week review of evidence on the safety and effectiveness of the three vaccines authorized for use in the United States and the applicable employment law. 

We worked with colleagues to develop the statement, which is being released at a time when the delta variant is now the dominant strain and cases are rising in locations where vaccination rates remain low. Recent data presented by the Centers for Disease Control and Prevention have shown that the vast majority of cases, hospitalizations, and deaths have been in unvaccinated individuals. 

This statement paves the way for healthcare facilities and personnel to communicate clearly that available COVID-19 vaccines are safe and highly effective. A fully vaccinated healthcare workforce reduces the risk of transmission and helps to protect healthcare personnel, their patients, their households and their communities. It supports a healthy workforce and the ability of healthcare facilities to continue to provide care to all patients. Healthcare workers are trusted messengers to their patients, peers, and the public, and the commitment of facilities to vaccine adoption maintains and builds trust in them.

The precedent for vaccination as a condition of employment in healthcare is extensive, and research shows substantial improvements in uptake following implementation of condition of employment policies. For example, organizations that made flu vaccination a condition of employment saw compliance rates of 94.4 percent compared to 69.6 percent in organizations without a requirement. Earlier this year, the Society for Healthcare Epidemiology of America endorsed influenza immunization as a requirement for those employed or functioning at a healthcare facility as recommended by CDC and Advisory Committee on Immunization Practices. 

But a policy of vaccination as a condition of employment involves much more than the nuts and bolts of employee vaccine clinics. Employers implementing such policies need to direct substantial time and resources to engage their employees early and often to develop a fair and ethical process that is in alignment with the facility's mission and culture. 

An approach based on the principles of diversity, equity, and inclusion likely will achieve the goal of broad immunity without generating controversy or resentment. Such an approach may include endorsement by senior leadership, appropriate education to healthcare professionals about the vaccines, removal of financial and other barriers to access (such as providing paid time off for vaccination and recovery from post-vaccination side effects), and locations and times convenient for HCP to get vaccinated.

If a healthcare institution determines that vaccination as a condition of employment is not possible, all efforts should be made to increase vaccination rates. If minimal adequate coverage is not achieved within a reasonable time, the facility should take the next step and implement a policy of requiring COVID-19 vaccination as a condition of employment. 

The path to controlling the COVID-19 pandemic includes vaccination of as many people as possible. HCP have been at the forefront of pandemic response, through patient care, research and policy. The publication of this multisociety statement further solidifies the commitment of healthcare personnel to end the pandemic.

Joshua K. Schaffzin, MD, PhD, is Director, Infection Control & Prevention, Cincinnati Children's and Associate Professor, University of Cincinnati Department of Pediatrics. Erica S. Shenoy, MD, PhD, is Associate Chief, Infection Control Unit, Massachusetts General Hospital and Associate Professor, Harvard Medical School. Both authors served on the writing panel that developed the "Multisociety Statement on COVID-19 Vaccination as a Condition of Employment for Healthcare Personnel." 

The "Multisociety Statement on COVID-19 Vaccination as a Condition of Employment for Healthcare Personnel" was written by the Society for Healthcare Epidemiology of America and representatives from AMDA – The Society for Post-Acute and Long-Term Care Medicine, the Association for Professionals in Epidemiology and Infection Control, the HIV Medicine Association , the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists. It was endorsed by all organizations.

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