Image of David Nace, MD MPH, CMD
David Nace, MD MPH, CMD

COVID-19 vaccinations should be mandatory for U.S. long-term care and other healthcare workers, according to long-term care physicians and a full range of other clinical specialists.

A group of experts from seven professional organizations on Tuesday released evidence-based recommendations following a panel discussion. Their verdict: healthcare institutions and facilities — including long-term care facilities — should require that their personnel be vaccinated as a condition of employment. 

If such a policy goes into effect, exemptions should apply to people with medical contraindications to all COVID-19 vaccines available in the United States, or as specified by law, the authors noted. The recommendations also support mandatory vaccination for ancillary employees, such as contract workers or volunteers.

The high efficacy of the vaccines authorized for emergency use in the United States top a list of factors that influenced the recommendations, said the authors, who include representatives from AMDA–The Society for Post-Acute and Long-Term Care Medicine, the Society for Healthcare Epidemiology of America, infectious disease and infection prevention experts and pharmacy and pediatrics professionals.

Although not yet fully approved by the Food and Drug Administration, those vaccines have similar safety profiles to shots that are fully approved, the authors emphasized. Full vaccination protects healthcare workers and the people they care for and their communities from infection, including asymptomatic or pre-symptomatic transmission of SARS-CoV- 2. In addition, the vaccines so far have retained “good effectiveness” against circulating coronavirus variants while preventing severe disease, they wrote.

The bottom line: Many workers are unlikely to get a shot without employer mandates, the authors argued. “Prior experience and current information suggest that a sufficient vaccination rate is unlikely to be achieved” otherwise, they said.

Time to move the needle on LTC vaccinations

The recommendations may serve as a wake-up call to long-term care operators and workers, co-author David A. Nace, M.D., MPH, told McKnight’s.

“I’m hopeful that this will help to start improving the vaccine uptake among employees in the long-term care workforce, because we really need to get those numbers up, said Nace, chief medical officer of UPMC Senior Communities and an expert in long-term care and flu programs.

“The LTC population is at the epicenter of this outbreak. This is where the mortality was, and this is where the mortality will be” if there are future waves of infections, he said. “And so we need to make sure we do everything we can to stop transmission now before more variants can start developing.”

“The one driver that does reliably predict high vaccination rates is simply whether or not they are mandated,” he said.

A strong case for vaccinating long-term care workers

The fear that employees will leave if shots are required is unfounded, Nace added. People want to keep their jobs, he said. “We know from flu vaccination programs that the workers don’t leave. If they leave because of mandates, you’ve got greater problems in your workplace.”

Other physicians support the recommendations. In fact, experts from Brigham and Women’s Hospital and Harvard Medical school have published a perspective stating that the case for mandating SARS-CoV-2 vaccination among healthcare workers is even stronger than the case for mandating influenza vaccinations — a policy that is widely accepted.

What’s more, the case for vaccinating workers in long-term care facilities may be even stronger than that of vaccinating people working in acute care hospitals, Michael Klompas, M.D., MPH, hospital epidemiologist at Brigham and Women’s Hospital, told McKnight’s.

LTC residents tend to be more frail and therefore susceptible to poor outcomes from infection, are at continuous risk of infection from care providers due to length of stay, and require more one-on-one help with activities of daily living, raising likelihood of transmission, he said.

In addition, long-term care facilities are more likely to have less stringent ventilation requirements than acute-care hospitals, Klompas said. And multiple SARS-CoV-2 outbreaks have been documented that stemmed from infections likely introduced by workers, he added. Those have affected both vaccinated and unvaccinated residents and have resulted in deaths.

“Vaccinating long-term care workers will help reduce the risk of these workers introducing and spreading SARS-CoV-2 amongst this most vulnerable of populations,” Klompas concluded.

Senior living companies have mandates in place 

Several senior living companies already have COVID-19 vaccine mandates in place. Among them: Aegis Living, ALG Senior, American House Senior Living Communities, The Arbor Co., Atria Senior Living, Civitas Senior Living, Enlivant, Five Star Senior Living, Juniper Communities, Harbor Retirement Associates, IntegraCare, Integral Senior Living, Jewish Home Family, Masonicare, Presbyterian Senior Living, Retirement Center Management, Silverado, Sunrise Senior Living, Trilogy Health Services and Trinity Health. 

Trinity’s mandate goes further than some and includes not only staff members but also contractors and others conducting business in facilities. Additional operators have said they are planning to mandate COVID-19 vaccination once the vaccine receives full approval from the FDA.