Will vaccine mandates worsen the ongoing health care shortage?

It’s great to meet you. I’m Yasmin Tayag, a science journalist and editor who’s been covering COVID-19 since the pandemic started. Needless to say, it’s been a wild 18 months, but it’s an honor to get the chance to share what I’ve learned with you.

Right now, we’re in the midst of a health care worker shortage. This problem isn’t new. Even before COVID-19 hit, researchers had predicted a shortage of 154,000 registered nurses by 2020 and 52,000 primary care physicians by 2025, caused by the growing elderly population, aging health care workforce, and passage of the Affordable Care Act. Then the pandemic happened, killing over 3,600 health care workers in the first year. High rates of COVID-related burnout are raising concerns that others will quit or retire early. 

Now, with health care vaccine mandates beginning to roll out in some states, some are worried that numbers will drop to even more concerning lows, especially in places where workers face termination if they don’t comply. The coming weeks will reveal the extent that these fears will materialize, but the early evidence is encouraging.

I want to make clear from the getgo that I think vaccine mandates are a good strategy. Widespread vaccination is by far our most critical tool for curbing the pandemic, and so far vaccine mandates have significantly helped raise vaccination rates. But mandates aren’t perfect, in part because a minority of the population resists them.

On Monday, New York implemented its vaccine mandate for health care workers. In preparation for the unvaccinated remaining by that date who would face termination, Gov. Kathy Hochul released a staff shortage contingency plan that includes calling in the National Guard as well as out-of-state, retired, and recently graduated medical professionals. So far, it looks like the plan won’t be needed: State data show that 92 percent of hospital staff were vaccinated by Monday’s deadline—a jump of ten percent from last week’s statistics—suggesting that shortages due to the unvaccinated might not be as dire as some predicted. 

Health care worker vaccine mandates in effect in other states are proving to be similarly successful. In California, many major hospitals have reported vaccination rates over 90 percent. In Delaware, the CEO of ChristianaCare, a major health care system, said that only one percent of its 14,000-person staff lost their jobs because of the policy. Over 99 percent of staff at North Carolina-based Novant Health reportedly chose to comply.

These numbers seem to suggest that the number of holdouts is small, which is promising. But even small decreases in the workforce can be disruptive in places where shortages are already serious.

In rural America, for example, vaccination rates are relatively low and hospitals are already understaffed. Losing even just a few employees due to vaccine mandates can mean having to turn patients away. The counterpoint, though, is that health care facilities run the same risk if unvaccinated employees get sick with COVID and are unable to work.

As hospitals fill up and demand for health care workers grows, it’s worth thinking about what might actually convince people who are on the fence to get the shot. Public health experts I’ve spoken to previously have underscored the importance of distinguishing between the vaccine-resistant (the small group known as anti-vaxxers who are unlikely to change their minds about vaccination) and people who are vaccine-hesitant, or on the fence for legitimate reasons. It’s the latter who may still be convinced, if their fears and concerns are addressed respectfully and nonjudgmentally. 

It may seem paradoxical that workers who have witnessed the worst of COVID firsthand might resist the vaccine. One reason is that they aren’t immune to misinformation on social media and in their communities. And though the data overwhelmingly shows that the vaccines are safe, some health care workers, like any other group of people, may still harbor fears about their own or their family’s safety. They must be reassured with factual information, delivered by someone they trust (like a personal physician or friend, as opposed to, say, a government official). In some cases, though, vaccine attitudes are also closely tied to political identity, which may also account for this paradox. A recent preprint reports that 23 percent of Republican health care workers are vaccine resistant, while only six percent of Democratic counterparts say the same.

It’s not going to be easy, but the more people who can be convinced to get vaccinated—whether through mandates or education—the less likely it is we’ll end up in an even more serious health care worker shortage than we are in now. 

Thanks for reading, and please reach out if you have any questions or comments—I’d love to hear from you.

Stay safe out there,

Yasmin Tayag

@yeahyeahyasmin

DIGITAL HEALTH

YouTube bans all vaccine misinformation. In an expansion of its previous policy, YouTube banned all videos spreading vaccine information from its platform. The company’s blog post on Wednesday stated that it would remove any content “that poses a serious risk of egregious harm,” like saying vaccines aren’t safe and effective or that they cause autism or infertility. To honor the importance of public discussion, however, it makes exceptions for personal testimonials (so long as they don’t promote vaccine hesitancy) and for other content about vaccine policy and trials. 

New data could expand Apple Watch’s heart-sensing capabilities. In 2017, the Apple Heart Study set out to determine whether the Apple Watch could detect irregular heart rhythms (arrhythmias), including those caused by atrial fibrillation, a serious heart condition. The device eventually got FDA clearance for its ability to do so (as well as for its electrocardiogram function). This week, results from a follow-up analysis of the same data showed that the device can detect arrhythmias other than atrial fibrillation, expanding its potential for medical use. (Fierce Biotech)

INDICATIONS

Editas finally shares data on CRISPR treatment. The Cambridge-based gene-editing biotech firm Editas was among the initial crop of companies to attempt to commercialize the groundbreaking gene-editing tool CRISPR. Its efforts have focused on treating a rare form of inherited blindness caused by a mutation in the gene CEP290, the idea being that using CRISPR to edit the gene will restore its function and, consequently, some level of vision. Results from its clinical trial, which started two years ago, are in: The treatment is largely safe, but its effectiveness is mixed. (BioPharma Dive)

THE BIG PICTURE

Telehealth is flourishing, but not in the places that need it most. Coronavirus shutdowns created the perfect conditions for telehealth to grow. And in a lot of places, it did—but not in rural America, where the easy access to medical care that telehealth can provide is sorely needed. For one thing, many rural areas still don’t have reliable broadband access. Restrictive interstate licensing rules and differences in reimbursement for virtual versus in-person care have made expansion and adoption difficult. Furthermore, some people are just not yet comfortable with virtual visits. Above all, say telehealth industry insiders, what’s lacking is government investment in rural infrastructure. (STAT News)

REQUIRED READING

Meet the International Science Reserve, the IBM-led project to prepare the world for future catastrophes, by David Meyer

Highly-vaccinated, but more cases than ever: Singapore shows the world what ‘endemic’ COVID might look like, by Grady McGregor

At the peak of the pandemic, health care workers were heroes. Now, they’re getting threats, by Heather Hollingsworth and the Associated Press