Should Frontline Health Care Workers Be Mandated to Receive the COVID-19 Vaccine?

The effects of COVID-19 continue to reverberate throughout the health care industry, particularly in long-term care facilities in which 5% of the US population reside, but 39% of the COVID-19 deaths have occurred.

Many nursing homes have long mandated that nursing staff be vaccinated for the seasonal flu, however mandating the COVID-19 comes with additional considerations. The COVID-19 vaccines currently being distributed by Moderna and Pfizer were permitted under Emergency Use Authorization (EUA) and have not be FDA approved. The EUA is a mechanism used during a disaster as a countermeasure to allow the use of medical products designed to diagnose, treat or prevent life-threatening conditions where there is no FDA approved alternative. Although these vaccines have gone through phase I, II, and III clinical trials, there is no current FDA approval.

Although COVID-19 has disproportionately affected people of color, a large proportion of long-term care facility staff who are black and brown have been reluctant to accept the vaccine I have seen. Some employees cite the rapid production under Operation Warp Speed as well as a history of medical experimentation on minorities by the health care establishment. A nurse in a facility cited the basis of her refusal to accept the COVID-19 vaccine as her uncle had been one of the 600 men who had been enrolled in the Tuskegee Study sponsored by the US Public Health Service from 1932-1972 in which 399 black men with syphilis were studied to determine the natural progression of the disease. The men were told they were being treated, however no medical interventions were provided.The nurse was warned by her family that the medical community commonly experimented on people of color, and she still believes the COVID-19 vaccine is an extension of this potential abuse.

There are several considerations that should be weighed before requiring that long-term care employees receive COVID-19 vaccinations. Rather than focusing on “sticks,” a campaign of education including the benefits to residents, co-workers and the community in general should be incorporated into human resources policies that provide staff with recognition, gift cards, a paid day-off, or other incentives to encourage participation. It is vital to keep the history of Tuskegee in mind when addressing the risks and benefits of COVID-19 vaccinations for front-line workers.