Public Health

How Permanente doctors are pushing ahead with a vaccine mandate

Jennifer Lubell , Contributing News Writer

The urgent quest to defeat COVID-19 has led to an unprecedented rise in vaccine mandates across the country, not just at the federal level, but in hundreds of health systems and a quarter of all hospitals. The AMA supports such a move, as well as vaccine mandates among all public and private sector employers.

Read the latest on COVID-19 vaccines

Get reliable information on developments in the authorization, distribution and administration of COVID-19 vaccines.

All eight Permanente Medical Groups, as part of integrated health care system-Kaiser Permanente, implemented such a requirement this summer following recurrent surges of the virus in its hospitals and clinics.

“As a health care leader, the way you demonstrate leadership during this pandemic is to get vaccinated and to mandate it,” said Steven Parodi, MD, national infectious disease leader for Kaiser Permanente and associate executive director for the Permanente Medical Group, a member of the AMA Health System Program.

To date, nearly all Permanente physicians and 80% of staff have gotten vaccinated.

Ahead of the president’s plan to require a vaccine mandate for all employers with 100 or more workers, at least a quarter of all U.S. employers were considering vaccine mandates as a condition of employment, according to a nationwide survey of almost 1,000 employers. In Dr. Parodi’s view, this is going to be part of a larger public health response, along with testing and masking to reduce transmission.

But mandates pose challenges, especially at a time of widespread labor shortages in health care and other sectors. Successful implementation calls for education at the ground level, addressing any fears or concerns about the science, noted Dr. Parodi.

Related Coverage

How to have crucial conversations with vaccine-hesitant patients

The mandate applies to all employees and physicians nationwide, in clinical settings and corporate office buildings. “We felt that we needed to apply a uniform standard for all people supporting our entire health care system,” said Dr. Parodi.

Kaiser Permanente does allow for medical exemptions that are properly vetted and signed off by a physician. Employees can also get an exemption based on their religious beliefs, provided they’re consistent with definitions by state or federal authorities.

“We have a verification process for those exemptions,” said Dr. Parodi. Any employee who gets exempted must undergo regular COVID-19 testing when public health guidelines apply.

Employees who do not provide proof of vaccination and who do not receive an exemption may be placed on leave for up to 45 days, which may result in termination.

The Permanente Medical Groups are trying to make it as easy as possible to do the right thing. “People get paid time off to get the vaccine as well. We’re trying to remove every single barrier,” said Dr. Parodi.

Employees and physicians have the option of going to a Kaiser Permanente facility or outside the health system. There’s a plentiful supply of vaccines, accessible through walk-in or after-hours visits, said Dr. Parodi. “If they do choose to get vaccinated at other sites, we have a process to upload their vaccine card, and depending on the state they’re in, get verification through the state.”

Related Coverage

Behind the wait on vaccinating younger children against COVID-19

No matter how easy it is to get a vaccine, some employees are not going to get it. Therefore, transparency is key, said Dr. Parodi.

Kaiser Permanente has arranged town halls for physicians and staff to hear about the reasons for imposing the mandate, and why it’s important for health care employees to get vaccinated. The organization has sent out informative emails and videos, developed patient-facing websites, and offered training for Permanente physicians and other health professionals on how to discuss the vaccine with patients. Managers have received talking points on fostering one-on-one conversations with employees. This is to reach those people who haven’t submitted their verification or haven’t gotten vaccinated.

Understanding barriers to vaccination is a first step, followed by alleviating fears or concerns. Sometimes, this involves dispelling some of the myths people are hearing online or in their communities, said Dr. Parodi.

The AMA has developed frequently-asked-questions documents on COVID-19 vaccination covering safety, allocation and distribution, administration and more. There are two FAQs, one designed to answer patients' questions, and another to address physicians’ COVID-19 vaccine questions.

The Permanente Medical Groups’ efforts have yielded impressive results: to date, up to 98% of its physician workforce is vaccinated. “We set a deadline of Sept. 30 that people need to be on the road to getting vaccinated,” said Dr. Parodi.

Nearly all U.S. doctors—over 96%—are vaccinated against COVID-19, according to an AMA survey conducted in May.

There’s an increased sense of urgency, not just from leadership but from the employee and staff level in meeting these goals, said Dr. Parodi. But not everyone has been quick to get their shot or report their results.

At the staff level, about 85% of employees in the Permanente Medical Groups have complied so far. Some of these people have yet to upload their verification information, either because they haven’t gotten around to it or because they’re only partially vaccinated. Another small percentage haven’t been vaccinated at all, either because they’re exempted or are refusing to do so.

It’s these holdouts managers need to reach out to for those one-on-one conversations, Dr. Parodi said.

Establishing a vaccine mandate takes courage and a willingness to make it happen, said Dr. Parodi. But it’s the right thing to do, he stressed. “It’s actually the way we’re going to get our arms around the pandemic.”

“I know this is hard. But taking this stand is critically important. More and more others are doing so,” he said. Through conversations with the Business Roundtable, an association of CEOs of large U.S. corporations, Kaiser Permanente has been influencing other employers to issue vaccine mandates.

Be ready to empathize rather than judge—and, if necessary, enlist additional people in these interventions. It may be the white coat that persuades someone, “but you may also need someone else in that person’s life to persuade them to go get that vaccine,” Dr. Parodi advised.

For more information on COVID-19 vaccine developments, visit the AMA vaccine resource guide.

And check out the AMA COVID-19 resource centerfor clinical information, guides and resources, and updates on advocacy and medical ethics.