Even as more hospital systems around the country enact Covid-19 vaccine requirements for their employees, some nurses still refuse to get vaccinated—choosing instead to resign or be fired, Meagan Flynn reports for the Washington Post.

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'This is the hill to die on'

On July 19, Valley Health announced a Covid-19 vaccine mandate for 6,300 employees at six locations, including Winchester Medical Center and Warren Memorial Hospital, with religious and medical exemptions being offered for eligible applicants, Flynn reports. And for most of its employees, the mandate has not been an issue—the organization reported that around 75% were already fully vaccinated.

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However, the mandate has also spurred numerous protests—many of which have included nurses—and pushback from local communities where vaccination rates are lower than those statewide.

According to Flynn, nurses protesting outside of Winchester Medical Center said they had weighed the risks of being unvaccinated, and considered vaccination the riskier option. Some cited rare but serious side effects, such as the risk of myocarditis linked to the Pfizer-BioNTech and Moderna vaccines, or the blood clot risk linked to the Johnson & Johnson vaccine. Others cited misinformation about the vaccines' potential effects on fertility, Flynn reports. And some said they already had natural immunity after being infected with the coronavirus last year.

Overall, the unvaccinated nurses described a "fear of the unknown," Flynn writes. Many of them believe that the vaccines have not been out long enough to be safe, or they feel uncomfortable with the increased pressure toward unvaccinated people to get a shot.

"We are not 'anti-vax,'" said Brittany Watson, a behavioral health nurse at the Winchester Medical Center. "We've done all the vaccines that you get when you grow up—but those have been around for decades. But this one, there's so much propaganda around it. It doesn't make any sense." Watson also organized a group called the "Valley Health Workers Association" for others opposed to the vaccine mandate.

Katie Hart, a certified family nurse practitioner at a Valley Health urgent care facility, said nurses might have been more willing to consider getting vaccinated if they didn't feel coerced into the decision. Now, however, Hart said they would not change their position, even if refusing the vaccine meant losing their jobs.

"This is the hill to die on," she said.

What's next for unvaccinated health care workers

"If people choose not to be vaccinated despite the evidence and the advice we've given and the information we've shared, and they choose to leave Valley Health or leave health care, we regret that they're leaving," said Jeffrey Feit, a physician and Valley Health's population health and community health officer. "But we respect them. We respect that's a choice people can make. We believe our choice has to be to really ensure the safety of our patients."

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Currently, it is unclear how many nurses or other workers may choose to resign or be fired instead of being vaccinated, Flynn reports. According to a Valley Health spokesperson, a complete count of terminated employees won't be available until the vaccine exemption process is completed. Current employees have until Sept. 7 to receive their first dose of a Covid-19 vaccine.

In the meantime, Edward Lloyd, an attorney, has said around 150 Valley Health employees have reached out to him for legal defense and are weighing their options against the mandate.

However, Margaret Foster Riley, a public health sciences and law professor at the University of Virginia, said the unvaccinated health care workers likely cannot make a case of their rights being violated—primarily because the country has a long history of legal vaccination mandates, especially for health care workers.

And although Covid-19 vaccines are currently only authorized for emergency use, unlike other vaccines that have been mandated, Riley said hospitals could argue that public health during the pandemic, particularly with the delta variant, "outweighs the right to choose whether or not you get to be vaccinated."

Some vaccinated staffers inside Winchester Medical Center have expressed unease about their colleagues' protests outside of the hospital, Flynn reports.

"Being in the health care profession, it's bigger than just yourself," said Sherri Thornton, an ED nurse at the hospital. "You've dedicated your life and your profession to taking care of people and doing no harm to anyone, and I think you have to protect not only yourself but your patients."

Thornton added she could not understand her unvaccinated coworkers' risk assessment for the vaccine. More than 1,000 Virginians are currently hospitalized with Covid-19—a first since April—Flynn reports, and the daily number of new cases is back to those seen in February.

And although hospitalizations in Thornton's unit are not yet up to levels seen in the pandemic's first wave, one thing has stood out to her: Every Covid-19 patient she has seen in the ED for the past two months has been unvaccinated. (Flynn, Washington Post, 8/14)