States: End HCW COVID-19 Vaccine Mandates
By Gary Evans
Twenty-two states have joined to petition CMS to stop mandating COVID-19 vaccines for healthcare workers.
Prior efforts to invalidate the CMS vaccine mandate reached the Supreme Court, which upheld the requirement for healthcare workers in a Jan. 13, 2022, ruling. “Vaccination requirements are a common feature of the provision of healthcare in America: Healthcare workers around the country are ordinarily required to be vaccinated for diseases such as hepatitis B; influenza; and measles, mumps, and rubella,” the high court ruled.1
In a Nov. 18, 2022, letter to HHS Secretary Xavier Becerra, West Virginia Attorney General Patrick Morrisey called for the vaccination requirement to be withdrawn.2
“The [CMS] rule has undermined healthcare quality by accelerating and prolonging a worker shortage,” Morrisey wrote. “The rule targeted the jobs of the very people praised as heroes for their bravery in providing care when the COVID-19 virus appeared in the United States. It has fueled a pervasive, nationwide worker shortage in the industry.”
Rural healthcare facilities have been hard hit by the exodus of staff due to mandated vaccines, Morrisey argued. More than 50% of nursing homes in eight rural states are understaffed.
“The primary motivation behind the rule was combatting the delta variant of COVID-19, which was both highly transmissible and still relatively deadly,” Morrisey wrote. “As of October 2022, the milder omicron variant was 100% of American cases. Thus, the particular threat that CMS originally used to justify the rule is gone.”
To clarify, CMS does not require the new bivalent COVID-19 booster for healthcare workers. Rather, healthcare workers who have taken an mRNA two-shot series or an approved one-dose vaccine are considered immunized.
Still, some hospital systems require the bivalent vaccine, which contains the omicron subvariant components B.4 and B.5. “We are requiring it at Vanderbilt,” says William Schaffner, MD, a veteran infectious disease physician and vaccine advocate.
While other hospital systems and states — like California — are following suit, some employees mutinied when a bivalent vaccine mandate was rolled out at Berkshire Medical Center in Pittsville, MA. The hospital subsequently dropped the policy — which mandated vaccination of its 4,000 employees — after a blistering petition signed by 890 workers accused management of “forced injection.”
In dropping the mandate, BMC released a statement saying while the booster may greatly reduce severity of illness, it may be less effective at preventing transmission. Apparently, the strongly worded petition was the catalyst for this change.
“Many of us were willing to sacrifice our bodies to help protect our patients, but if that is not what we are doing now, this most recent vaccine mandate is nothing more than bullying by an employer for profit,” the employee petition states. “In a recent email, BMC announced that the pandemic was over and employees would no longer be paid for time when they are sick with COVID. If the pandemic is over, and employees must use their own time for illness, then why are you forcing vaccines that do not reduce transmission?”3
The question becomes one of whether the SARS-CoV-2 bivalent immunization can blunt the threat to healthcare workers and patients, particularly since the latest viral iterations have shown the ability to escape vaccine immunity. While breakthrough infections and subsequent transmission remain issues, the bivalent vaccines showed “additional protection” in a recent study by the CDC.4
“Among symptomatic adults who received testing for SARS-CoV-2 infection at pharmacies nationwide during September 14-November 11, 2022, bivalent mRNA vaccines provided additional protection against infection compared with previous vaccination with two, three, or four monovalent vaccines alone,” the CDC reported. “Results from this study show that bivalent boosters provide protection against symptomatic SARS-CoV-2 infection during circulation of BA.4/BA.5 and their sublineages and restore protection observed to wane after monovalent vaccine receipt. Results limited to the period of BA.4/BA.5 predominance were not meaningfully different … when BA.4/BA.5 sublineages (including BA.4.6, BA.5.2.6, BF.7, BQ.1, and BQ.1.1) predominated.”
As of Nov. 8, 2022, the Institute for Health Metrics and Evaluation (IHME) at the University of Washington reported more than 1 million people have died of COVID-19. The institute’s modeling projects that rate climbing to 1.1 million COVID-19 deaths by March 1, 2023.5 That is an increase of 40,000 deaths over about three months and three weeks, which is similar to a continuation of the 330 deaths reported on Nov. 27, 2022, which translates to about 10,000 deaths a month.6 This prediction is a more of a plateau than the highly anticipated winter surge.
REFERENCES
- Supreme Court of the United States. Joseph R. Biden, Jr., President of the United States, et al v. Missouri, et al. Xavier Becerra, Secretary of Health and Human Services, et al v. Louisiana, et al. Jan. 13, 2022.
- Morrisey P. Centers for Medicare and Medicaid Services Interim Final Rule, Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination, RIN 0938-AU75. Nov. 18, 2022.
- Panetti T. COVID vaccine mandate. Petition.net. October 2022.
- Link-Gelles R, Ciesla AA, Fleming-Dutra KE, et al. Effectiveness of bivalent mRNA vaccines in preventing symptomatic SARS-CoV-2 infection — increasing community access to testing program, United States, September-November 2022. MMWR Morb Mortal Wkly Rep 2022;Nov 22. doi: http://dx.doi.org/10.15585/mmwr.mm7148e1.
- Institute for Health Metrics and Evaluation. COVID-19 Projections. Updated Nov. 17, 2022.
- The New York Times. Coronavirus in the U.S.: Latest map and case count. Updated Dec. 1, 2022.
Twenty-two states have joined to petition CMS to stop mandating COVID-19 vaccines for healthcare workers. In a Nov. 18, 2022, letter to HHS Secretary Xavier Becerra, West Virginia Attorney General Patrick Morrisey called for the vaccination requirement to be withdrawn.
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