James M. Berklan
James M. Berklan

You’re not alone if you think you’ve heard enough about making COVID-19 vaccinations a condition of employment. For better or worse, the issue isn’t going to go away anytime soon. On that everyone can agree.

Why? Well, because those meddlesome worriers so eager to impose mandates on caregivers intensified their campaign this week.

Meanwhile, those stubborn, selfish louts who don’t care about making the public drastically safer also are not going to budge off their position.

Identity with either one of these camps? It would be odd if you didn’t at this point.

Nobody knows that better than David Nace, M.D., MPH, who is very familiar with vaccines, mandates, eldercare and public health, among other issues. He is the chief medical officer for UPMC Senior Communities and oversees about 3,000 patients at about 30 buildings, on 21 campuses in central and eastern Pennsylvania. Vaccine rates among them are above 90% for residents and around 64% for staff, according to the most recently available figures. 

I spoke with Nace on Thursday, largely because of his long background as a flu vaccination specialist. He offered comments based on that, as well as his role as the immediate past president of long-term care’s medical directors association (we’ll call it AMDA).

History, he notes, is on the side of making something as important as COVID-19 vaccinations a condition of employment. No need for the “m” word, he says. Vaccination can simply be an imposed condition for someone who wants to be employed in a certain place. Especially if that person wants to work around the frail elderly.

“They [mandates] are already essential to what we do with a wide variety of conditions — measles, mumps, rubella, pertussis, hepatitis B,” Nace pointed out. “They will protect patients.”

Employee incentives can be helpful but will raise compliance only to 60% or 70%, he added.

“Research I published about the flu experience shows this. You will get to maybe 70%,” he explained. “If you want to get to 80% or 90%, the only way is making [vaccination] a condition of employment.”

EUA elimination helpful?

Having a vaccine lose its “Experimental Use Authorization” label will not usher in a great era of vaccine uptake, Nace believes: “No way. People use that as an excuse. But even if it’s EUA approved, you can still mandate it as terms of employment.”

David Nace, M.D.

He cited a federal court’s dismissal of a lawsuit against a Houston health system’s mandate in June as an example. (Plaintiffs vowed to appeal.)

“Out of 26,000 employees, 158 refused to get the vaccine, the number shrunk even further, and they ended up firing 110 out of 26,000,” he said. “That’s a fraction of their workforce and, frankly, those are the employees you don’t want. You want people dedicated and believing in science. [If they aren’t,] they can go to another facility with lower vaccination rates, and then lower their care.”

He also wants to make clear that despite the EUA label, the vaccines are not experimental treatment. 

“It’s absolutely wrong to say that,” he emphasized. “It’s not experimental in any way, shape or form. The vaccine technology has been out there for decades. It’s just the first time it’s been used for this condition. EUA means it’s still approved for treatment and no longer experimental. It’s being used as an additional means to find additional data, to further quantify the safety benefits.”

Going nowhere

Nace says if employees do leave a job site, it will be because of a “toxic” work environment caused by other factors such as pay — not because of a vaccine that has been proven beneficial to hundreds of millions of people.

“People say they will go elsewhere. That is bunk. We know from the flu vaccine that is bunk,” he said. “People don’t leave because of hepatitis or influenza vaccines.”

He said that the 90,000-employee UPMC medical system has had a mandatory vaccination program for those illnesses for years [though not COVID-19 yet] and only a relatively few people have declined the shots. More than 97% have complied.

“People say that [they’ll leave] all the time. It’s a myth. We need to stop saying they will,” Nace stressed. “There are employees who don’t like masks or to wash their hands. You have the right not to wash your hands or wear a mask — but you don’t have the right to work at this particular institution. When you agree to join, you agree to procedures. You have to follow those, based on patient safety.”

For those old enough to remember, there was once a protracted battle over whether seatbelt use could be legally mandated. It would infringe upon personal “rights,” was one big plank of that campaign, right up there with: “But it would needlessly wrinkle my clothes.” Seriously. 

In the years since, however, arguments about the legality or logic behind seat belt mandates have disappeared. 

Yet people wearing seatbelts still die every year, Nace quickly points out. Nothing is perfect, he reminds, but some measures clearly enhance safety. That’s one of his major thrusts when it comes to COVID vaccines.

“There are a lot of crazy theories out there [about the COVID vaccines] that have not been proven,” Nace said. “You can kind of look for studies to bolster your position, but it’s irrational, serial thinking. We know [the vaccine] works, we know it lowers mortality.”

Dying to prove a point

He’s optimistic that a greater percentage of people will become vaccinated, albeit slowly. 

“Nationally, one of the things that’s driving this is that the people dying are the ones not vaccinated. People are seeing friends who are not vaccinated, unfortunately, get sick or have pretty nasty illness. Unfortunately, vaccinations were a politicized issue, and a lot of misinformation was put out there. People will see cases going up among the unvaccinated group.”

Nace believes that patient expectations could deliver some providers the fortitude needed to make vaccinations a condition of employment.

“Residents and family members ask about it all the time. There’s that expectation out there and families will start to choose a facility based on that,” he observed. “If they’re planning to go for surgery or rehab, they always ask exactly what the COVID status is in the building. People will be driven toward safety and care. [Providers] that try to cut costs and are less apt to rock the boat with regard to what they are doing will probably be the ones that lose out.”

Follow Executive Editor James M. Berklan @JimBerklan.