Watch the AMA's COVID-19 Update, with insights from AMA leaders and experts about the pandemic.
In today’s COVID-19 Update, AMA Chief Experience Officer Todd Unger discusses the complex issue of vaccine mandates with three health system leaders: Robert Hart, MD, chief medical officer, Ochsner Health, Adnan Munkarah, MD, executive vice president and chief clinical officer, Henry Ford Health System and Michael Anderson, MD, chief medical officer, Virginia Mason Franciscan Health in this special COVID Update feature.
Learn more at the AMA COVID-19 resource center.
- Robert Hart, MD, chief medical officer, Ochsner Health
- Adnan Munkarah, MD, executive vice president and chief clinical officer, Henry Ford Health System
- Michael Anderson, MD, chief medical officer, Virginia Mason Franciscan Health
Unger: Hello, this is the American Medical Association's COVID-19 update video and podcast. I'm Todd Unger, AMA's Chief Experience Officer in Chicago. Today, we're bringing you a special in-depth look at the complex issue of vaccine mandates. There's no question that the development of safe, effective COVID vaccines has been a game changer in the pandemic, but while vaccines are widely available and have been since the spring, progress in getting our country fully vaccinated has been slow. Vaccine mandates increasingly appear to be one of the most effective ways to increase our vaccination rates and make sure that more people are protected. The science is clear, but efforts to mandate vaccines at both the federal and the local levels have been met with pushback and legal challenges. In July of this year, the AMA, along with 55 other health care organizations and societies, issued a joint statement in support of COVID-19 vaccine mandates for all health care and long-term care workers. The AMA stands with health system leaders who've been issuing mandates to help protect their workforce, their patients, and their communities.
For this episode, we spoke to a cross section of health system leaders about how they're navigating vaccine mandates: one in Louisiana, one in Michigan and one in Washington state. I'd like to thank Dr. Robert Hart, chief medical officer of Ochsner Health in New Orleans, Dr. Adnan Munkarah, executive vice president and chief clinical officer at Henry Ford Health System in Detroit and Dr. Michael Anderson, chief medical officer of Virginia Mason Franciscan health in Tacoma, Washington, for sharing their stories. We started by asking each health system leader to explain their rationale for implementing a vaccine mandate. Dr. Anderson started us off, saying it wasn't that different than requiring employees to get a flu vaccine.
Dr. Anderson: When you see that there is an influenza vaccine requirement that is in place, you know that that is an organization that is focused on the culture of patient safety. We get those annual vaccines to primarily protect our patients, so that we don't introduce influenza to someone who's already susceptible to it and perhaps has other comorbidities that could make their medical condition worse. The second piece to that is we also want to ensure that we protect our staff members, because during flu season, or now during COVID season, we're dependent upon every single employee. So by providing these vaccines and requiring them, we're able to increase the presence of our staff and they feel safer about being able to work in this environment. And finally, our communities will come to us when they know that we've created this safe environment.
Unger: Dr. Hart said Ochsner looked at who was getting seriously ill from COVID, and the answer was clear.
Dr. Hart: If you go back to the hospitalizations, many of those hospitalizations were in people who were unvaccinated. 90%, 85, 90% were unvaccinated people. So we had begun letting our staff know throughout the organization that when the government gives full approval for the vaccine, we are going to mandate this. We think it's the right thing to do. This is about a couple of things. This is about being the right thing to do for our staff, keeping them safe when they're here in the hospital and when they're in our clinics, taking care of people.
But it's also about providing a safe place for our patients to come. Nobody wants a patient to come in and actually get an illness or be infected coming in to see us. We also began having some patients who are asking the question, “Hey, is my staff that takes care of me here vaccinated?” So we began doing work early on in setting people up to really understand that we think this is the right thing to do from a safety, from a quality and from a community need, that it's going to be the right thing to do to mandate these vaccines.
Unger: Dr. Munkarah talked about how Henry Ford relied on data and an evidence-based approach.
Dr. Munkarah: First, it is living up to our mission and vision to make sure that we are the trusted partner in care for our community and that we are helping to improve the lives of our community. We looked at the data. We weighed the data. We looked at evidence. We looked at science and made sure that when we felt that the vaccines are effective and safe, and when we felt that just asking people to get the vaccines without mandating it, asked our staff to get vaccinated without the mandate, is not getting us to the numbers that provides enough immunity to serve the community and protect the community. This is where we made the decision to mandate.
Unger: We also learned that health systems took different approaches in laying the groundwork for their mandates and communicating it to employees.
Dr. Anderson: Because in the state of Washington, if you're a health care worker and you're not fully vaccinated or have not received an exemption, then you are not allowed to work in a health care environment. Therefore, it was pretty simple to explain that to our staff members because it was the same message that was going out all across the state, to all the systems.
Dr. Munkarah: We put a deadline of September 10 for all people to be vaccinated or to get the exemption. And we allowed for medical as well as religious exemptions, with very clear guidelines of who qualified for these medical and religious exemptions, and making sure that we are sensitive as well as respectful to people's needs. Everybody who worked with us was expected to get vaccinated, part-time, full- time staff, contingent staff, our medical students, nursing students, our volunteers, as well as our contractors. Tried to take every single path and venue that we can have to connect with our employees.
Dr. Hart: We gave a couple of months lead time. I think it was August 24. We came out and said, "Okay, we have until October 30 to get everyone vaccinated." We wanted time to be able to educate, answer questions, and we did a lot of that between August 24 and October 30. We had open forums every time we turned around. We were trying to answer questions about the vaccine, the value of the vaccine, the safety of the vaccine, how it could protect us. So I think we did an awful lot to try to bring people along with education and really just trying to individualize.
It started out with the big Zoom sessions and then we went to individual sessions. We'll come meet you. We had infectious disease doctors that would come meet with an individual behind closed doors, just one on one, to answer any particular questions that they had, trying to make sure everyone knew they're safe, the efficacy is good, and it's the right thing to do.
Unger: All the health system leaders that we talked to said that while there was still more work to be done, their mandates had largely been successful.
Dr. Anderson: There's always opportunity for improvement anywhere we look, but we're getting very, very close in that direction, with over 96% of our staff members and medical staff members being fully compliant and working today in our hospitals across the Puget Sound. I'd like that to be up to 98, 99, even 100% there. But again, this is an opportunity to shape culture throughout our organization towards that idea of we're doing this to keep our patients safe, to keep our communities confident in our ability to protect them.
Dr. Hart: We had a long ways to go to get people where we really wanted them to be and percentages of people vaccinated, because we were probably sitting, at that point as an organization, we were probably around 50%. In the state, we were less than 30%. In the organization, we were probably no more than 50%. So we had a long way to go. We're above 98% now. So I think when you think about going from around 50% up to 98% over a two and half month period, very pleased with that.
Dr. Munkarah: So, it is very, very clear that vaccines are making a dent. We know that the data is very convincing that the vaccines are effective. So this is why today we continue to promote and encourage vaccination. Obviously we have 99% of our staff, in fact, 100% now because everybody has got vaccinated and some individuals decided to leave. But we continue to encourage our community to get vaccinated, everybody who is eligible for the booster to get the booster, children to get vaccinated, because you are seeing outbreak in schools, and for people to follow all protective measures and abide by all protective measures that we know have worked. Which is masking, social distancing, avoiding large public gatherings where there are a lot of people who might not be vaccinated, because we are seeing very concerning surges at the present time, and our hospitals are full and our health care system is significantly, significantly strained.
Unger: But implementing a vaccine mandate doesn't come without challenges, including reaching employees who are hesitant.
Dr. Anderson: The staffing issues associated with a vaccine requirement are tremendous if you're fearful that half your staff are going to walk out the door. Therefore, a lot of the preparation that gets us to the point that we're at was based on that creating a culture, again, of patient safety. In other words, focused on protecting the patient, protecting the communities that we serve, then reduces some of those concerns about, well, what is the risk of the vaccine to me, for me? Now, it did help that we were able to deliver over 300,000 doses of the mRNA vaccines and J&J vaccine prior to the requirement coming out. Our health care workers got to see that those individuals weren't coming back with complications from their vaccine, and they also experienced the devastating fact that many of the people that were being admitted with COVID-19 infections during the sixth surge were unvaccinated.
Unger: With new variants continuing to emerge, we also wanted to know if health systems were beginning to mandate boosters.
Dr. Munkarah: We have been strongly encouraging our staff, as well as our community and family members and patients to get the booster vaccines. We've not mandated it at the present time because there are a lot of elements and factors as we are looking at mandating boosters that come into play, breakthrough infection, people who might have a breakthrough infection who got monoclonal antibodies. So we really feel that we are in a good place and we have allowed our staff and their families, not allowed, encouraged them in fact, to seek booster vaccine wherever is more convenient to them, whether it is in pharmacies, whether it is at other sites, if they don't have the time to do it while they are at work or through employee health.
Dr. Hart: We really have tried to push the fact that getting the booster, we know it boosts the immune response to COVID, but there's probably going to be some cross protection between the boosters that we have, the vaccine that we have now and Omicron. So we really are using that to reinforce the idea that boosters are important. They will help in the long run, but we can't take our eye off the ball of getting those that are unvaccinated at all to go ahead and get vaccinated.
Unger: In a recent statement, AMA President Dr. Gerald Harmon said, "We know that the vaccine mandates work. They result in more people getting vaccinated. Now is the time for the public and private sectors to come together, listen to the science and mandate vaccinations so we can defeat the COVID-19 pandemic."
Thank you again to Dr. Hart, Dr. Munkarah and Dr. Anderson, three health system leaders who, like so many others, are doing their part to help end this pandemic for all of us. That concludes our COVID-19 update on vaccine mandates. We'll be back soon with another COVID-19 update video and podcast. For updated resources on COVID-19, visit ama-assn.org/COVID-19. Thanks for joining us, and please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.