While residents of nursing homes and their caregivers have been considered a top priority for COVID-19 vaccination, only 38% of nursing home staff accepted shots when they were offered, new data from the Centers for Disease Control and Prevention revealed Monday.
Anecdotal reports have been circulating for weeks that nursing home staff members were turning down vaccination offers, but these are the first national-level figures.
“These findings show we have a lot of work to do to increase confidence and also really understand the barriers to vaccination amongst this population,” said Dr. Radhika Gharpure, lead author of the study and a member of the CDC’s Vaccine Task Force.
The report cited previous polling data to suggest why employees have been declining vaccines.
Many raised concerns about vaccine side effects. Others said they didn’t want to be among the first to receive the vaccines, which were first authorized in December. Some said they didn’t trust the government, or referenced false claims about the shots.
It’s also possible, Gharpure said, that some people didn’t get vaccinated because they weren’t working when the shots were distributed, or because they work in multiple facilities and were only counted at one.
Residents, meanwhile, have been much more accepting of vaccines, with 78% receiving at least one shot, according to the new report, which examined vaccination rates at more than 11,000 long-term care facilities nationwide between Dec. 18 and Jan. 17.
Any extra doses of vaccine are being returned to the states, although there are no national-level figures to determine how much is being returned, said Dr. Ruth Link-Gelles, a report co-author and the CDC’s lead for its Pharmacy Partnership for Long-Term Care Program.
The Trump administration initiated the Pharmacy Partnership with drugstore chains CVS and Walgreens, who agreed to pay three visits to every participating nursing home, vaccinating as many people as possible the first two times, and providing the second required dose on the later visits.
The vaccines are provided for free with the pharmacies billing private insurers and Medicaid and Medicare for administration fees.
More staff members are signing up for shots on the second and third visits, suggests the hesitancy may be waning at least somewhat, Link-Gelles said.
That matches the drugstore chains’ experience.
“Generally speaking we are seeing a higher uptake by staff members on our second visits,” said Mike DeAngelis, senior director of corporate communications for CVS.
Walgreens said it is learning from the reticence of nursing home workers.
“While vaccine hesitancy has been a challenge at some of these facilities, our pharmacists have played a critical role in providing education and information to help residents and staff understand the important role these vaccines will play in helping the nation emerge from this pandemic,” Walgreens president John Standley said in a statement.
Lack of information about the vaccines may explain some of the hesitancy, the report concluded.
The Trump administration promised for months that it would launch a public information campaign about the vaccines but it never materialized.
A nursing-home specific “toolkit” became available late last year, at about the same time vaccinations became available. The Centers for Medicare & Medicaid Services and private groups are also launching communication initiatives.
Link-Gelles said she understands that the vaccine is new, and hopes more people will take it as they see it working well in others.
“Hesitancy, we’ve seen has been a problem not just in this group but across the country,” she said. “Other data has shown that as people have become more comfortable with the vaccines and … obviously not seeing a lot of very serious adverse events, that people will become more comfortable. This population is hopefully no different.”
Healthcare worker acceptance appears to increase in facilities that have done more to educate staff members about the safety and effectiveness of the COVID-19 vaccines.
Dr. William Schaffner, an infectious disease expert at the Vanderbilt University School of Medicine, Nashville, Tennessee, said his hospital has gone to extraordinary lengths to provide information for staff – both in groups and one-on-one.
It’s been worthwhile, he said, because they have “moved the needle” of staff opinion, from nearly two-thirds hesitant late last year, to 75% agreeing to receive the vaccine early this year.
Now, he said, they’re reaching out those who still remain hesitant, with “people on our faculty who look like them,” to try a more individual approach.
Particularly disturbing, he said, are false rumors that the vaccine can affect fertility. “Balderdash,” Schaffner said at the idea. “It’s amazing the nonsense that’s out there.”
There is no biological plausibility to the concern about fertility, Schaffner said. The Pfizer-BioNTech and Moderna vaccines, which use a technology called messenger RNA, don’t get into the nucleus of the cell, so they can’t affect the cell’s genetic code.
“No sooner does this messenger RNA deliver its message, it disintegrates and the body gets rid of it, so it does not persist in the body,” he said.
Also countering the rumors that the vaccine blocks fertility, Schaffner said several hundred people in the vaccine trials, who were asked not to get pregnant while volunteering actually did.
“So, obviously, you can become pregnant even though you’ve received the vaccine,” he said, noting that pregnant women who become infected with COVID-19 are more apt to have a serious bout of illness.
But it’s important to respect the concerns of those who are hesitant to take the vaccine,he and other experts stressed, listening to what they say and addressing their concerns with real information.
At CommonSpirit Health, which includes 139 hospitals and more than 1,000 care sites in 21 states, about 80% of staff members have either been vaccinated already or say they are likely to be vaccinated, said chief nursing officer Kathleen Sanford.
Sanford credits her organization’s high rate of acceptance to surveys conducted to understand hesitancy and efforts to educate staff members. “No matter how good your education is and your communication, sometimes you need to repeat yourself,” she said.
The company’s leaders post pictures of themselves getting vaccinated, Sanford said, and many who initially said they wanted to “wait and see” how other people fared on the vaccine are starting to change their minds.
Most health care facilities, including nursing homes, are not requiring staff to get vaccinated against COVID-19 but they are strongly encouraging it and hoping to reach levels of flu vaccination, which now generally top 90%.
About 42% of workers at Ballad Health, which serves 29 counties in Northeast Tennessee, Southwest Virginia, Northwestern North Carolina, signed up for a shot at first, said Jamie Smith, the organization’s chief infection prevention officer. But as of last Monday, 56% of the network’s health care team has gotten their first dose.
“It’s what we expected,” Swift said. “We knew that we had people that would just want to wait, see how the process went and talk to their co-workers. It’s one thing to hear the national statistics, it’s another to talk to someone you work next to about how they felt about getting vaccinated.
For many being vaccinated is surprisingly emotional, and that’s also true for the staff who are giving shots to their co-workers.
“For so long we have dealt with extreme sickness. Just to be able to give the vaccine has been such a healing process. People just cry,” Swift said.
She’s seen that there’s a real change in attitude after the first couple of people in a unit get vaccinated.
“These are health care workers on the front lines, facing a battle that not everyone sees every day. It’s just the sense of relief and hope, it reenergizes that entire unit when you have someone get vaccinated.”
Kathleen Unroe, a geriatrician and nursing home physician, helped conduct a survey in November of front-line health care workers across Indiana on behalf of the state department of health.
Her study, which was cited in the CDC’s new report, found that 45% of more than 8,200 healthcare workers would consider getting vaccinated immediately after it was available, and another 44% was willing to consider getting it in the future.
Although she wishes the vaccination rate were higher, Unroe said she’s encouraged by those figures. Some want to wait until they see others, especially people they trust, take the vaccine safely.
“I get that,” Unroe said. “If they need to take a little time to look at it, I think that’s reasonable.”
Unroe said the Indiana nursing home facility where she works has faced a long list of challenges over the last year coping with the pandemic.
But now, 70% of staff have been vaccinated, and she hopes that persistence, solid messaging, and helping people talk through their fears will bring most of the rest around.
“The vaccine provides hope for us and a way out,” Unroe said. “So I think we will get there.”
Elizabeth Weise contributed to this report.
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