Houston Methodist CEO Marc Boom this month explained why he decided to mandate that staff get vaccinated for Covid-19 in an op-ed for MedPage Today—even as other hospitals and health care organizations continue to grapple with the decision.

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Background

In December 2020, the Equal Employment Opportunity Commission (EEOC) said employers who mandated staff get vaccinated against Covid-19 would not violate federal disability law or civil rights statutes on discrimination—but only if they provided employees excluded from the workplace because of their vaccination status accommodations such as telework or leave, and permitted exemptions for those refusing the vaccine on religious grounds.

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And according to a poll conducted by the Washington Post and the Kaiser Family Foundation in April, nearly 60% of employed health care workers said they would support their organization mandating that all staff who work with patients get vaccinated.

However, the poll found that, among the roughly 30% of health care workers who said they did not plan to get vaccinated or had not yet made a decision, more than 80% said they would oppose their employer mandating the vaccine—and nearly two-thirds said they would rather quit their job than receive the vaccination. Among all employed health care workers, the poll found about one in six would leave their job rather than be vaccinated.

Such mandates for health care workers are more popular among the general public, the Post reports. According to the poll, 70% of non-health care workers said they would support a mandate requiring health care workers who interact with patients to be vaccinated.

Amid this division, according to the Post, at least seven companies that care for older or infirm patients have said they plan to require their employees to get the shots, including Atria Senior Living—which announced that its 10,000 or so employees must have had at least one shot by May 1—and Sunrise Senior Living, which said all of its employees must be fully vaccinated by the end of July.

Houston Methodist announces mandate

According to the Post, Houston Methodist in early April became the first health system in America to announce that all of its 26,000 employees across its outpatient facilities and eight hospitals would be required to be vaccinated. All employees are required to be vaccinated by June 7.

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Writing for MedPage Today, Boom said the Covid-19 vaccines aren't "the first time our industry has stepped up and made vaccines mandatory." For instance, he notes that flu vaccines for health care workers—voluntary "[n]ot that long ago"—are now required in 17 states. "If we mandate flu vaccines for these numbers [between 12,000 and 61,000 deaths per year since 2010], we must also mandate Covid-19 vaccines given how much more deadly it is," he writes.

Since Houston Methodist issued its mandate, the health system has effectively established herd immunity, Boom continues, noting that more than 89% of the staff has received the vaccine. "Already we're seeing positive results: the number of employee infections has dropped as the number of vaccinated employees has risen."

Ultimately, according to Boom, health care organizations mandating Covid-19 vaccines would not only promote the safety of patients and staff alike, but it would also "allo[w] us to set an example for those who are hesitant to get vaccinated" by demonstrating that "we trust the safety and efficacy of the vaccine."

So, he concludes, "healthcare systems and employers, please join Houston Methodist in making the vaccine mandatory for staff—and do so quickly. The sooner we're able to end this pandemic, the fewer lives will be lost and the closer we can get to normal."

Mandates remain controversial

According to the Post, despite Houston Methodist's decision—and the guidance from EEOC—many other health care organizations remain hesitant to mandate the vaccine among staff.

That’s in part because, while several vaccines have received emergency use authorization (EUAs) from FDA, none have yet been fully authorized, the Post reports. Under FDA's EUAs, each person who receives the vaccine must provide consent. As a result, according to Lawrence Gostin, a professor at Georgetown University Law Center, requiring people to get "a vaccine that's only authorized for emergency use is a gray area of legality and may be unlawful."

So while hospitals across the country "are beginning to ask the question, 'Should we?'" when it comes to the Covid-19 vaccine, said Nancy Foster, VP for quality and patient safety at the American Hospital Association, many aren't ready to make a firm decision.

For instance, Amy Compton-Phillips, chief of clinical care at Providence, where about 70% of staff was vaccinated as of early April, said while she would "love to mandate" a coronavirus vaccine, the health system doesn't "feel we can do that" without FDA issuing full approval.

Compton-Phillips added, "We'll think about it down the road. As we get more and more data on how safe it is, how well it works, how long lasting the protection is, it will be much easier to mandate the vaccine" (Goldstein, Washington Post, 4/5; Boom, MedPage Today, 5/2).

Editor's note: An earlier version of this story misidentified Houston Methodist as Houston Medical.