Hospitals and other health care providers in Maine are weighing whether to mandate COVID-19 vaccines for employees amid a push from national organizations representing doctors, nurses and other health workers.

On Monday, more than 50 organizations representing millions of health care professionals across the country urged all health care employers to require COVID-19 vaccinations for their employees. The groups – including the American Medical Association, the American Nursing Association and the American Academy of Pediatrics – endorsed a vaccination mandate at a time when the delta variant is causing another surge in coronavirus infections, hospitalizations and deaths nationwide.

“We call for all health care and long-term care employers to require their employees to be vaccinated against COVID-19,” the groups said in a joint statement. “We stand with the growing number of experts and institutions that support the requirement for universal vaccination of health workers. While we recognize some workers cannot be vaccinated because of identified medical reasons and should be exempted from a mandate, they constitute a small minority of all workers.”

The strong national endorsement was welcome news to leadership of the Maine Hospital Association, which represents hospitals on regulatory and legislative issues in Augusta.

“We are very supportive,” said Steve Michaud, the association’s president.

The Maine Hospital Association began advocating for a statewide mandate for all health care workers last month. Michaud said Monday that he hopes the national push will “lend some urgency” to similar discussions among groups in Maine. He also hopes the Maine Department of Health and Human Services will proceed with a statewide COVID-19 vaccination mandate for all health care workers as the agency did for the influenza vaccine late last year.

“I’m not sure when or if that will happen, to be honest with you,” Michaud said. “So now we are looking at what do we do … as the hospital field. We are just starting those conversations. But the bottom line continues to be the safety of our patients.”

A spokesman for the Maine Center for Disease Control and Prevention, Robert Long, said Monday that federal courts have established that health care employers and universities can mandate COVID-19 vaccinations for staff and students. While several private Maine colleges are requiring vaccination for students and staff returning to campus this fall, the University of Maine System and some employers are waiting for the vaccines to receive full regulatory approval before taking that step.

VA AND CALIFORNIA NOT WAITING

“Maine CDC will continue to share expertise and information with hospitals and other employers as they make decisions about workplace safety, as well as continue to closely monitor the FDA approval process for COVID-19 vaccines,” Long said.

All three of the vaccines currently being administered in the United States – from Pfizer, Moderna and Johnson & Johnson – have received emergency use authorization but have not yet received full approval from the U.S. Food and Drug Administration.

Some states and government agencies are not waiting for full FDA approval.

On Monday, the U.S. Department of Veterans Affairs announced that more than 100,000 medical employees throughout the VA system will have to be vaccinated. California plans to begin requiring COVID inoculations for all health care workers and state employees beginning next month.

In Maine, vaccination rates among workers vary dramatically in different segments of the health care industry and even among facilities within the same sector, according to data from the Maine CDC.

For instance, 86.5 percent of staff at ambulatory surgical centers and 78.8 percent of hospital staff were vaccinated against COVID-19 as of June 30. Those percentages drop to 70.7 percent for nursing homes and to 66.3 percent for homes or facilities that care for people with intellectual disabilities.

MANY AWAIT FULL FDA APPROVAL

Several hospitals and healthcare providers in Maine said they aren’t requiring vaccines for employees or haven’t made decisions yet. Some said they wouldn’t require the vaccine while it is still in emergency use authorization from the FDA.

“This is an issue we are watching closely, for the health of our caregivers and our community,” Dr. Jennifer Cutts, chief medical officer for York Hospital, said in a statement. “We strongly encourage all of our caregivers to voluntarily receive the vaccine, though have not yet made a decision to require it.

“There are a variety of factors entering into this decision, including full FDA approval of a vaccine, and the current discussion at the Maine state level regarding whether or not all Maine healthcare workers will be required to receive the vaccine.”

At MaineGeneral Health in Augusta, spokeswoman Joy McKenna said the system also has not mandated vaccinations for staff because of the existing emergency use authorization. The MaineGeneral Medical Center in Augusta had a vaccination rate of 71.1 percent among staff as of June 30, according to data from the Maine CDC.

“If the vaccines become fully approved by the FDA, then we will re-evaluate whether to make the vaccinations mandatory for employees,” McKenna said in an email.

At Northern Light Health, a Brewer-based network of hospitals, nursing homes and primary care facilities, spokeswoman Karen Cashman said the network is “aware of changes at other organizations across the nation, and we are consulting with clinical experts at the state on the best approach.”

Of Northern Light’s 12,342 employees, 79 percent are vaccinated, according to the network’s latest numbers. “Our focus remains on voluntary vaccination, education and outreach,” Cashman said.

John Lamb, a spokesman for InterMed, a medical group centered on primary care, said it is continuing to encourage but not mandate that employees receive vaccines. Steve Amendo, chief marketing officer for Martin’s Point Health Care, also said that while it is not currently requiring vaccinations, the group is discussing it in light of the joint statement released by the American Medical Association, American College of Physicians and other national groups.

“We are happy to report that the vast majority of our employees have received the vaccine and we continue to work to make it easily accessible for all,” Amendo said in an email.

FLU VACCINE WAS MANDATED

Last fall, Maine DHHS moved forward with plans to require influenza vaccines for all health care workers. More than 30 people – including doctors, nurses, technicians and other caregivers – spoke against the mandate during a public hearing, with many saying it violated the “informed consent” and constitutional liberties of health care workers.

On Monday, a representative for the Maine State Nurses Association, the union that represents nurses at several hospitals and health care networks, declined to comment on the debate over mandatory COVID-19 vaccinations. But union President Cokie Giles testified against mandatory flu vaccinations for health care workers during the November 2020 public hearing on the proposal.

“It does not mean that we’re anti-vaccination,” Giles said, according to a DHHS transcript of the hearing. “We feel that should be a choice given each individual.”

Board members of the Maine Health Care Association, which represents nursing homes and long-term care facilities, planned to meet Monday afternoon to discuss the issue in order to provide feedback to the American Health Care Association. The national group had not signed onto the joint statement because it wanted feedback from state-level groups.

“One of the key points for the organization all along … has been if you are going to make a mandate, it needs to apply to all health care workers,” said Nadine Grosso, vice president of the Maine Health Care Association. “That is a conversation that we have been having … it is very important to us that certain health care workers are not singled out and that it would apply uniformly.”

While Grosso said she couldn’t presuppose where the association would fall on the issue, she added: “I think it’s safe to say that our board and our members are all fully aware of the importance of vaccination and the need to do this. They just have get their head around it.”

John Porter, spokesman for MaineHealth, the state’s largest health care network, including Maine Medical Center in Portland, said the network doesn’t have a position on whether there should be a state COVID-19 vaccination mandate, but a future requirement for MaineHealth workers is “under discussion.” A total of 87.4 percent of MaineHealth’s 23,000 employees are vaccinated, according to the most recent numbers.

OUTREACH AND EDUCATION KEY

Meanwhile, senior administrators at Millinocket Regional Hospital will meet Tuesday to discuss vaccinations for employees. Todd Phillips, an infection prevention specialist at Millinocket Regional, said the small rural hospital has a vaccination rate of 94.4 percent among its 231 employees. Phillips said the hospital, which was one of the first to mandate flu vaccines for employees years ago, has yet to do the same for the COVID shot and achieved the current rate through outreach and education.

“We pretty much built consensus through surveys, education and one-on-one time and giving them the info they needed,” Phillips said. “We didn’t mandate or pressure people. We just gave them the information and we’re really glad they made the right decision.”

At Hallowell Family Practice, a small private practice with two physicians, Dr. Scott Schiff-Slater supports having doctor’s offices and hospitals requiring their staff to get vaccinated. Schiff-Slater said the small number of employees at his practice weren’t required to be vaccinated, though all have been. He said if he were going to hire someone, he would ask that they get vaccinated.

“The science is so strongly in favor of it right now,” Schiff-Slater said. “The economics might also help them decide because so many patients are asking to go places where the staff are vaccinated. Hospitals might find it’s in their best interest to have all the staff vaccinated.”

Still, Schiff-Slater said a decision to mandate vaccinations for staff is a complex one. In his own practice, Schiff-Slater said some employees expressed hesitancy about getting the vaccine, although all eventually did.

One of them was Tina Clark, who works as a patient services representative checking patients in and answering phones at the practice. Clark said she normally doesn’t take the flu vaccine because she used to get it years ago and it made her feel sick. She changed her mind about the COVID vaccine after contracting the virus at a medical office where she had an eye exam.

“I was ready to get it,” said Clark, who received her first shot in January and the second in February. “I didn’t want to feel that way again and my husband was the same way.”

Clark said she was undecided, however, on whether healthcare employers should require the vaccine for their staff.

“I think it is a really good idea and should be strongly encouraged because after catching it and getting sick, it was terrible,” Clark said. “I definitely agree it should be strongly encouraged that everyone should get it, but as far as (making it) mandatory, I feel it should be up to the individual as well.”

HESITANCY AT NURSING HOMES

Nursing homes and group homes have consistently faced among the biggest challenges in vaccinating some workers, despite the high death toll from the virus in such facilities last year and early this year.

Several assisted-living facilities reported 100 percent vaccination rates as of the end of June. While some nursing homes, such as the Maine Veterans Homes in South Paris and Scarborough, had staff vaccination rates of approximately 90 percent, at least six nursing homes around the state were below 50 percent and many were between 50 and 60 percent.

Grosso, at the health care association, said reasons for the disparities vary, but that it often “depends on the temperature of the folks who are working in those facilities.”

“I don’t know if you can point to any one trend,” Grosso said. “For me it goes back to that, all along, it really has been an individual decision.”

 

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