New York mandates vaccines for health workers – how will it play out?

E rie County Medical Center, a hospital in the western New York city of Buffalo, just recorded its highest single-day patient count ever – 553 patients in a facility licensed for 573 beds – but not because of an influx of Covid-19 cases.

Instead, hospital leaders said the caseload is the result of a New York state vaccine mandate – the first statewide “vaccinate or terminate” mandate to be implemented in the nation.

“We support the vaccine mandate,” said Tom Quatroche, president and chief executive officer of the medical center. However, “we’ve consistently asked for a little more time to strategize with the state on how we can also address the effects and reality of the mandate.”

When New York’s vaccine mandate went into effect this week, administrators put one-fifth of the corporation’s long-term care facility staff on unpaid leave – workers who have risked their jobs rather than get vaccinated. The resulting staff shortage has caused a “cascading effect” through the entire system.

“That’s the biggest challenge, is on the nursing home side,” said Quatroche. “The lack of staffing has created closure of units and inability to discharge individuals out of the hospital, which backs up the hospital and blocks beds for individuals who need beds in the emergency room.”

The result of these factors in Erie county – difficulty hiring, vaccine hesitancy and a state requirement – presents just one example of the forces hospitals across the country will face as more state vaccine mandates from California to Maine go into effect.

While Erie county presents an extreme example, it is far from alone in New York. State data showed 87% of hospital workers in New York were vaccinated as of Wednesday. A federal vaccine mandate for more than 100 million workers across the US, which will include health workers, is still being written.

“Frankly, I don’t think a health worker who refuses a vaccine has a leg to stand on,” said Georgetown University law professor Lawrence Gostin.

Gostin said vaccine mandates are necessary, urgent, ethical and, importantly, legal. He also said there was no evidence to show they have caused staff shortages in the past, when vaccines have been required for diseases such as influenza.

“It’s certainly true that everything about Covid has been politicized,” Gostin said. “But it doesn’t change the scientific facts, and the scientific facts are that Covid vaccines are just as safe as influenza vaccines, and far more effective, and it doesn’t change the fact that Covid-19 is a far more dangerous disease with greater pathology than influenza.”

Mandates appear to be working in New York, even amid the challenges faced by Erie County Medical Center. Democratic governor Kathy Hochul announced Sunday that vaccine compliance among nursing home workers increased from 70% to 92% when the mandate went into effect Monday.

A lawsuit over religious exemptions in New York means workers seeking these dispensations can continue working until 12 October.

The first hospital chain in the nation to require vaccination, eight hospitals known as Houston Methodist in Texas, achieved a 99% vaccination rate across 26,000 health workers and employees in June. The chain lost only about 150 employees, and a federal lawsuit attempting to stop the mandate was thrown out of court. A hospital group in North Carolina this week had a similar experience, with all but 1% of employees complying with a vaccine mandate.

Nevertheless, the health industry is nervous after two years of punishing caseloads, a workforce worn thin and traveling “agency” nurses demanding sky-high rates of $150 to $200 per hour, Quatroche said.

“While the importance of having all healthcare workers vaccinated is unquestioned, this is coming at a time when many hospitals are facing serious staffing shortages,” said Jan Emerson-Shea, spokesperson for the California Hospital Association.

“It’s hard to predict exactly how the vaccine mandate will play out – every hospital is implementing its own processes and procedures.” She added: “It is possible that some healthcare workers may choose to leave their employment rather than get vaccinated.”

More than 64% of Americans have received one dose of a vaccine, and more than 55% are fully vaccinated with a high degree of regional variability, according to the Centers for Disease Control and Prevention. The US has struggled to vaccinate its population, with a plodding campaign that has fallen behind peers in the G7, a club of seven highly developed, populous democracies.

“The fact that we’ve politicized the vaccine doesn’t change the safety or the efficacy risks, and it doesn’t change the responsibility of health workers to protect their patients,” said Gostin. “If that were true, then any disinformation or any false belief would be sufficient to create a hazard in the health system. And that’s just untenable.”