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Adriane Fugh-Berman and Caroline Renko column: Mandate COVID-19 vaccinations in care facilities
Containing the virus

Adriane Fugh-Berman and Caroline Renko column: Mandate COVID-19 vaccinations in care facilities

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By Adriane Fugh-Berman and Caroline Renko

About one-quarter (29%) of the public is reluctant to take the COVID-19 vaccine; surprisingly, a similar proportion of health care workers, including doctors and nurses, also are avoiding the vaccine.

More than 200,000 health care workers have been infected by COVID-19. One in nine coronavirus cases in California is among health care workers. This is appalling: Health care workers not only are at the highest risk of getting infected, but they are efficient vectors who can infect large numbers of people.

This has been well demonstrated in nursing homes and long-term care facilities, where one-third (33%) of all COVID-19 deaths in the United States have occurred; at least 179,000 residents and staff in these facilities have died from the virus.

Those infections didn’t come from visitors, who were banned from nursing homes and long-term care facilities early in the pandemic. Most cases likely have been transmitted to residents by low-paid employees working in understaffed conditions without adequate personal protective equipment.

These staff have the closest contact with patients, and many have multiple jobs at different facilities to make ends meet. As a result, low-paid staff have been both victims and vectors in an epidemic of avoidable deaths.

Nonetheless, 60% of nursing home workers have refused to take the first dose of the vaccine. This is unacceptable. Not only will the COVID-19 vaccine lower individuals’ risk of getting a severe case, it also lowers their risk of killing other people.

Vaccinated people are less likely to transmit COVID-19 even if they get it. The more people who are vaccinated, the less the virus spreads in a population.

When the vaccine first was rolled out, health care workers were given priority; this made sense, given their roles and their vulnerability. What happened next was unexpected; appointment slots went begging, and vaccines had to be thrown out because health care workers were not showing up for appointments.

Some low-wage workers might have had difficulties making or getting to an appointment, but worries about safety and side effects are far more common. A survey done of 8,243 long-term care staffers in Indiana found that 70% of the 4,539 not willing to take the newly available vaccine cited concerns about side effects as the primary reason.

Similarly, a survey of health care workers by the Kaiser Family Foundation found that many who stated they were unlikely to get the vaccine worried about side effects.

In real-life settings, COVID-19 vaccines reduce infections and hospitalizations, thus alleviating burdens on the health care system, and they are likely to reduce deaths. Residents in care facilities are at high risk of dying, and staffers in those facilities are at the highest risk of transmission.

A recent poll found that 1 in 6 health care workers would rather leave their jobs than be vaccinated. That’s fine. Health care workers who won’t take the vaccine are risking not just their own lives but other people’s lives.

An individualistic approach will not cut it; either we are all in or we lose more precious lives. No staff should be allowed to be in contact with patients in any setting, residents of long-term care facilities or other workers at these facilities without being vaccinated. COVID-19 vaccinations should be mandatory for all health care workers.

Adriane Fugh-Berman, M.D., is a professor of pharmacology and physiology and family medicine at Georgetown University Medical Center. She directs PharmedOut, a research and education project at the university that promotes rational prescribing.

Caroline Renko is the project manager of PharmedOut.

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