Infectious Disease Expert Dr Hilary Babcock Addresses Vaccine Mandates in Healthcare Settings

As COVID-19 infections and hospitalizations rise in the United States — especially due to the delta variant — groups led by the American Medical Association and the American Nurses Association have called for mandatory vaccinations of healthcare personnel.

In a recent interview with Chief Healthcare Executive™ Hilary Babcock, MD, MPH, infectious disease specialist, Washington University and BJC Healthcare in St. Louis, Missouri, discusses a COVID-19 vaccine mandate, as well as other vaccine mandates in healthcare settings. Babcock said healthcare workers signed up to look out for the health of themselves and others, and getting vaccinated is part of that job.

CHE: With the delta variant surging, and new data showing breakthrough cases are increasing, what steps can be taken in healthcare settings to keep the virus at bay among uninfected patients and personnel?

Babcock: There are a lot of things that healthcare organizations have been doing over the whole past year to protect patients and employees during this COVID pandemic. And a lot of those continue today and need to continue. And those include using our personal protective equipment, doing screening of patients to be sure we identify people who may have COVID quickly so they can be appropriately isolated, screening of our employees to be sure that people aren't coming to work sick. And then the biggest advance in being able to control this spread in healthcare is the same as it was in the community was the availability of these very effective vaccines. So really encouraging and doing everything we can to get high vaccination rates in our communities, and then also among our employees, as well.

CHE: The American Medical Association called a vaccine mandate for healthcare personnel part of the “ethical commitment” of healthcare workers to patients. Can you address that and what it means to you?

Babcock: As healthcare workers, we all, you know, signed up for a job that was primarily providing care for others and putting others first and looking out for their health and well-being. And so the vaccine is one way that we can protect ourselves. And that serves two purposes. One, it keeps us healthy and safe and able to go to work and continue to do our jobs and be sure that staffing doesn't create safety problems for our patients. And it also protects our colleagues and coworkers and patients, because if we were to come to work with COVID, we would put all of these people at risk. And putting people at risk is not why we went into healthcare. We went into healthcare to keep people safe and to try and make them well.

CHE: Your organization is already requiring COVID-19 vaccinations. When was that decision made and what went into it?

Babcock: We decided to require COVID vaccination as a condition of employment, probably near the end of May. It was announced in mid June and our deadline for compliance is in September. We already have in place requirements for influenza vaccination every year and for other recommended vaccines for healthcare workers. For us, in many ways, it was just a natural progression for that, here is another vaccine that is recommended for healthcare workers that can protect our patients and our employees. And so we should treat it the same as these other vaccines that we already require.

CHE: What was the reaction from personnel at the hospital and was there any fallout?

Babcock: In general, I would say most people were not super surprised because we already have this in place for other vaccines. And so it wasn't, you know, out of left field for us to require or recommend a vaccine for our employees. Many of our employees are pleased because they would prefer high vaccination rates in their colleagues and coworkers, and so they were pleased that it would be treated the same way. You know, some employees still had some concerns about the vaccine, still have some worries about the vaccine. A mandate or condition of employment is not just a switch that you can turn on. So it goes along with continued education and outreach. We had a lot of town halls for our whole organization. We've had smaller town halls on request for specific areas where people have concerns. We had a specific town hall focused on women's health and fertility and pregnancy and breastfeeding, and concerns and questions around that with some of our OB-GYN and fertility specialists. We've done a lot of outreach and education and we are now also including, it's an incentive program for people who have been vaccinated get entered into a raffle and could win some money for being vaccinated. So that condition of employment is important. It puts a deadline, it shows our commitment, but it doesn't get us out of having to do all of these other things that we want to do with our employees to be sure that they feel safe and comfortable getting this vaccine.

CHE: It is not uncommon for healthcare organizations to require other vaccinations. How are those typically handled and what is the difference with the COVID-19 vaccine?

Babcock: I think the main difference between the other vaccines that we require and this one is that we don't yet really know exactly what the schedule will be. So we don't know for sure whether this is a one-and-done vaccine series or whether we will need boosters. And if we need boosters, when will we need boosters, who will need boosters? So we know that we can require the vaccine of everyone right now with allowances for medical and religious exemptions. But we don't know whether we will have boosters we need to require, whether those will apply to everyone or just to some of our population. So that's a little bit different than the other vaccines that we've required.

CHE: As we move to full FDA approval for the vaccines, do you expect or hope to see some of the resistance melt away?

Babcock: I'm hopeful that the FDA will provide full licensure soon. I don't think there's any doubt that they're going to license the vaccines. We have really extensive data — they’ve been used in millions of people — we have a lot of safety data, we have a lot of efficacy data. I don't think there's any question that it will be licensed. I think having it fully licensed will be reassuring to some people and so hopefully that will help with some of the concerns. I don't think it will take care of everything. There is a lot of active misinformation that is being put out there for whatever nefarious reasons to try and discourage people from getting these vaccines. And so that's a real barrier and that will not be addressed, I think, by the licensing.

CHE: You coauthored a paper supporting the CMS rule that hospitals must report COVID-19 vaccination coverage among healthcare providers. Why is a similar rule in place for flu vaccines and what is the benefit of enacting it for COVID-19 vaccines?

Babcock: Influenza vaccination is reported as a quality and safety measure to the CDC and has been for years. And the goal of that is to encourage healthcare organizations to take seriously the importance of reaching high influenza vaccination coverage rates among their employees to keep, again, their employees, their colleagues, and coworkers, and their patients safe from influenza. And having it publicly reported and using it as a safety measure encourages organizations to really push for those high levels and do whatever it takes to get to high levels of vaccine coverage. Adding the COVID-19 vaccine to that program would have the same effect. So we’ll really show that the government thinks it's important, that the CDC thinks it's important, that it is a quality measure for a healthcare organization to have high levels of COVID vaccine coverage among their employees. And so we’ll really have a similar impact, hopefully, in driving people to do whatever it takes to get high levels of vaccine coverage among their employees.

CHE: Is there anything you would like to add?

Babcock: The most important thing that anyone can do to help get us through and out the other side of this pandemic into a more normal life again, is to get vaccinated. Get your friends and family vaccinated, tell all of your acquaintances and colleagues to get vaccinated. Really just whatever we can do to get that vaccination rate up higher will really help us get through this faster.