Hospitals and other health care settings are filled with some of the most vulnerable people in society, by nature. Some years ago, as part of an effort to keep patients safer, it became the norm for hospitals and other health care settings to require flu and other common vaccinations for all employees. Some were initially skeptical of this policy, but it’s now widely accepted. Today, most would agree with both the science and the common sense behind hospital vaccination polices: Inexpensive, easy-to-administer and proven vaccines for influenza, measles, tuberculosis and other infectious diseases are the best and easiest way to keep our patients safe.
A year and a half into this pandemic, with hundreds of millions of people now vaccinated worldwide and many dozens of clinical trials completed, science and common sense are once again in agreement. It’s clear that COVID vaccination should be required for health care workers.
Still, some remain hesitant, despite the overwhelming scientific evidence that these vaccines are safe and effective with few side effects. This position is understandable, particularly for communities of color. Historically, these groups have, at times, had painful and unjust experiences with the health care establishment.
While we recognize this, it is our duty to focus first on protecting the health of our patients, our communities and our employees. Those who are unsure about getting vaccinated for their own health, should consider universal vaccination as a reflection of the higher standards that already exist for health care workers, especially when it comes to the safety of patients. Just as speed limits protect all cars on the road, and fire codes protect entire cities, vaccinations are not about keeping one person safe. Rather vaccines serve to keep everyone safe.
As health care professionals, we have a solemn responsibility to prevent disease wherever possible and to devote ourselves to the welfare of those in our care. By receiving the COVID-19 vaccination, we can do both. For these reasons, our two health systems and schools of medicine will require COVID vaccination for our employees.
We did not make this decision lightly. We respect those who feel hesitant or simply resent the idea of a requirement. We acknowledge these valid concerns, and we are committed to doing the hard work necessary to help our employees understand the need for universal vaccination in health care. As is often the case when we talk about vaccination, we should reiterate the scientific facts. On this front, there is no shortage of powerful evidence to support our position.
For example, a CDC study of more than 1,800 health care workers found that two doses of either the Pfizer or Moderna vaccine had about 94% efficacy against symptomatic COVID. This probably underestimates the vaccines’ value, because many of those who are infected and have symptoms likely have only minor issues, such as sniffles or a sore throat. Likewise, a 2017 review looked at flu vaccination and found that health care institutions with requirement policies had much higher vaccination rates than institutions that did not. Another study, from 2010, reviewed a large medical center in Virginia and found that after it implemented a flu vaccine requirement, vaccination rates rose from 54% to more than 98%.
Some opponents argue that it is too soon for a requirement, because the three vaccines now being used in the U.S. have only received an Emergency Use Authorization from the Food and Drug Administration (FDA), and have not yet been fully approved by the agency. However, all three vaccines have been studied carefully, and in fact, the data on safety and efficacy reached a higher standard than what the FDA requested. Regulators typically want a vaccine to show 50% efficacy; that is, it reduces the risk of disease by at least half. So far, all vaccines approved for use in the United States have almost completely prevented severe illness, hospitalizations and death among those who are infected. Moreover, for all three vaccines, serious side effects are extraordinarily rare, less than five incidents per million doses.
We understand that this position may generate some controversy. As leaders of our respective institutions, we understand that we have a duty to educate and support our teammates to embrace the vaccine, and we remain focused on that work. Yet we also maintain a duty to our patients and public, and to the foundational tenets that underpin everything we do in health care. Putting our patients first means requiring the vaccine for our workforce.
Kevin W. Sowers (presidentsowers@jh.edu) is president of the Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine. Mohan Suntha (suntha@umm.edu) is president and chief executive officer of the University of Maryland Medical System.