COVID-19 Vaccination Requirements for Nursing and Medical Students and the Contagion of Misinformation

Just when many of us thought we saw a light at the end of the COVID-19 pandemic tunnel, the rate of immunizations declined and a more contagious variant of the virus found enough susceptible hosts to start another wave of illness and death. Depending on where you live, you already witnessed the veracity of the Delta variant, are in the middle of trying to deal with it, or are starting to see and feel its effects. This is especially poignant for all of us in health care—and in my world of health care education.

Last year, when there was no vaccine, everyone in health care education improvised and adopted alternative strategies for clinical learning. Individual states and state agencies issued emergency declarations, and guidance to help students meet requirements was provided by organizations such as the Accreditation Council for Graduate Medical Education,¹ the National Council of State Boards of Nursing,² and the American Association of Colleges of Nursing.³

Especially after vaccine supplies became more predictable and steady, most emergency declarations expired or were lifted. In many parts of the United States, nursing and medical students played an important role in vaccination efforts. Enter the second era–if you will–of health care education during this pandemic: the unvaccinated student in a health professions program.

In July 2021, the Association of American Medical Colleges released a statement recommending its members require vaccinations for all employees.^3,4 Later that month, 50 health care professional societies and organizations released a joint statement in support of COVID-19 vaccine mandates for all workers in health and long-term care. Signatories included, among others, the American Academies of Ambulatory Care Nursing, Child and Adolescent Psychiatry, Family Physicians, Nursing, Ophthalmology, Physician Assistants, Pediatrics, and Allergy, Asthma & Immunology as well as the American Medical, Nursing, Pharmacists, Psychiatric, and Public Health Associations, the American Association of Colleges of Nursing, and the Wound Ostomy and Continence Nurses Society.⁵ Many US universities already mandate proof of COVID-19 vaccination for students, and the number of hospitals and health care facilities that require COVID-19 vaccinations of all students is increasing. Whereas some facilities allow exemptions for employees, these exemptions generally do not apply to students. Students are not employees. They are guests. And unvaccinated guests, who may be 3 times more likely to test positive for SARS-CoV-2 than vaccinated people, should not be in close contact with vulnerable populations.⁶ Implementing these new requirements has become the most recent educational challenge for, among others, schools of nursing and medicine.

What is puzzling is that students who practice in health care facilities are very familiar with adhering to health requirements, including obtaining immunizations for many vaccine-preventable diseases. Unfortunately, the misinformation, fear, and mistrust that has flattened the COVID-19 vaccination curve did not pass them by, fueled by a variety of organized efforts from groups that stand to benefit. Their efforts make those of Andrew Wakefield and his devotees look like child’s play.⁷

What can we do? Share the facts. Health care professionals and health care professionals-to-be are, after all, in the field of the sciences. Share the publications detailing the original vaccine safety and effectiveness data, including the number of adverse events in the placebo groups.^8-10  Remind people that the studies were conducted with large sample sizes and included people with all sorts of health conditions. Ergo, some people died. But these deaths were not vaccine related. In fact, the Moderna, Johnson & Johnson, and Pfizer vaccine studies reported more deaths in the placebo than in the vaccine arms of the study.^8-10 This illustrates that these were truly population-based, controlled studies.

We have applied extraordinary efforts to, and made amazing progress in, the war against this virus. From the efforts of clinicians who shared their observations and outcomes when treating COVID-19 patients, to the researchers, the vaccine study volunteers and manufacturers, and the local, state, and federal employees who set up vaccination sites, science has helped us get a handle on COVID-19. Science will guide us through the current and upcoming spreads of variants. We can continue to do our part to help make sure real data and science spread faster than the rapidly mutating virus and misinformation. In so doing, we will not only protect ourselves but will ensure that there will be newly licensed health care professionals to fill the many current and future staffing gaps.

The opinions and statements expressed herein are specific to the respective authors and not necessarily those of Wound Management & Prevention or HMP Global. This article was not subject to the Wound Management & Prevention peer-review process.

REFERENCES

1. Accreditation Council for Graduate Medical Education. Guidance Statement on Competency-Based Medical Education during COVID -19 Residency and Fellowship Disruptions. September 22, 2020. Accessed January 8, 2021. https://www.acgme.org/Newsroom/Newsroom-Details/ArticleID/10639/Guidance-Statement-on-Competency-Based-Medical-Education-during-COVID-19-Residency-and-Fellowship-Disruptions/

2. National Council State Boards of Nursing. Changes in Education Requirements for Nursing Programs during COVID-19. June 22, 2020. Accessed June 24, 2020. https://www.ncsbn.org/Education-Requirement-Changes_COVID-19.pdf

3. American Association of Colleges of Nursing. Considerations for Reopening U.S. Schools of Nursing during COVID-19. July 28, 2020. Accessed July 29, 2020. https://www.aacnnursing.org/Portals/42/News/AACN-Guidance-Reopening-Schools-COVID-19-July-2020.pdf

4. Association of American Medical Colleges. AAMS Statement on COVID-19 Vaccine Requirements for Medical School and Teaching Hospital Employees. July 16, 2021. Accesssed August 8, 2021. https://www.aamc.org/news-insights/press-releases/aamc-statement-covid-19-vaccine-requirements-medical-school-and-teaching-hospital-employees

5. Joint Statement in Support of COVID-19 Vaccine Mandates for all Workers in Health and Long-term Care. Accessed August 8, 2021. https://www.acponline.org/acp_policy/statements/joint_statement_covid_vaccine_mandate_2021.pdf

6. Elliott P, Haw D, Wang H, et al. REACT-1 round 13 final report: exponential growth, high prevalence of SARS-CoV-2 and vaccine effectiveness associated with Delta variant in England during May to July 2021. Imperial College London (pre-print). August 4, 2021. Accessed August 10. https://spiral.imperial.ac.uk/handle/10044/1/90800

7. Deer B. The Doctor Who Fooled the World: Science, Deception, and the War on Vaccines. Johns Hopkins University Press; 2020

8. Sadoff J, Gray G, Vandebosch A, et al. Safety and efficacy of single-dose Ad26.COV2.S vaccine against Covid-19. N Engl J Med. 2021;384:2187–2201. doi:10.1056/NEJMoa2101544

9. Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. 2020;383:2603–2615. doi:10.1056/NEJMoa2034577

10. Baden LR, Hana M, Sahly EI, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med. 2021;384:403–416.doi:10.1056/NEJMoa2035389