Why Aren’t More Health Care Workers Getting Vaccinated?

Juliette Negron loves her work caring for the most fragile newborns at Oishei Children’s Hospital in Buffalo, New York. But the pandemic has created new anxieties for Negron, a registered nurse. “We’re all a little more uneasy,” she explained. In the neonatal intensive care unit where she has worked for the last twenty-five years, rates of COVID have been low. “Obviously, we have to interact with parents, and we’ve had positive moms. Subsequently we test the babies,” she said. So far, her tiny patients have stayed virus-free. But she knows that could change, that they or she could fall ill.

The arrival of COVID-19 vaccines should be good news for Negron, but she told Intelligencer that she hesitated to get the shot: “I did have some questions.” So did Susan Philip, a physician assistant at Richmond University Hospital Center in Staten Island. Although vaccinations promised personal safety, and an end to a year of worry, Phillips said her relief was mixed with a fear of the unknown. “I was a little reluctant about taking it myself, because I wasn’t sure what the long term side effects would be,” she said.

Philip eventually overcame her reservations. So did Negron. They’ve both gotten the shot. But many of their fellow health care workers have yet to do the same: Ohio Governor Mike DeWine said that about 60 percent of the state’s nursing home workers have declined to be vaccinated. Governor Andrew Cuomo expects 30 percent of New York’s health care workers to refuse the vaccine when offered, the Wall Street Journal reported last month. Experts believe vaccine hesitancy among health care workers may become a significant obstacle in the federal government’s quest to immunize the public. But why are they hesitant?

The reasons are complex, and only some are specific to COVID itself. The anti-vaxx movement seeds social media with conspiracy theories and hoax cures, and once the pandemic hit, disinformation proliferated. But health care workers like Negron and Phillip also spent the last year on the frontlines of a relentless and confusing crisis. When the virus first appeared in the U.S., the Trump administration stumbled, issuing contradictory safety recommendations to health care workers. They often lacked protective gear. Some even blew the whistle on their own employers, risking their livelihoods to reveal deadly safety lapses in nursing homes and hospitals across the country. Now the same employers are asking workers to get a new vaccine.

In the absence of a vaccine mandate, informational campaigns may be the best way to convince hesitant workers to get their shots. Those campaigns may be successful when they’re run by organizations workers trust: take unions, for example. Negron and Philip both belong to 1199SEIU, which represents over 400,000 active and retired health care workers in five states plus the District of Columbia. Both credit union outreach for answering their questions and encouraging vaccine compliance in their workplaces. That campaign may provide examples for frustrated public health officials to follow.

“What we know is that the number one motivator for our members taking the vaccine is getting all their questions answered,” said Gabrielle Seay, who is director of political action for 1199SEIU. As vaccines became more widely available, the union launched a campaign aimed at reassuring skeptical members. Union leaders have organized town hall meetings and webinars by Zoom, and set up an email account to field questions from members who are deciding whether or not to take the vaccine. To further press the case for vaccination, the union even updated an old labor tradition for an era of remote work: It’s producing digital pamphlets for members. A new union publication, The Frontline News, runs quotes from Dr. Anthony Fauci of the National Institutes of Health alongside messages from various union leaders and fellow members. All stress the importance of vaccination. One issue shows a photo of union president George Gresham getting a shot in the arm himself.

The union opposes a vaccine mandate for health care workers, and its campaign avoids shaming or coercing members who are suspicious of the vaccine. Instead, 1199SEIU wants to present them with the facts. Though side effects and the occasional rare complication can follow any vaccination, the Moderna and Pfizer/BioNTech vaccines being administered across the country are safe. “Let’s follow the advice of these trusted experts,” urged one January issue of the Frontline News. “We’ve already missed too many big moments and lost too much. With these vaccines, we can get our lives back.”

That’s the right angle to take, said Dr. Georges Benjamin, the president of the American Public Health Association. Health care workers are well-educated, he said, and after a year of watching patients and coworkers die from the virus, they understand the stakes of not getting vaccinated. “While they’re not opposed to taking the vaccine probably in most cases, they’ve heard the scientific debate and in many cases, they just don’t want to be first in line,” he explained. That reluctance will likely fade the longer the vaccine is available, he added. As more of their colleagues get vaccinated and suffer no ill effects, “more and more of them will certainly come on board.” There’s a difference between vaccine hesitancy and vaccine refusal, he stressed. Like 1199SEIU, Benjamin believes a vaccine mandate is unnecessary.

Mandates could also inflame certain factors that contribute to vaccine hesitancy. Health care workers may distrust their employers; they may also distrust the medical community itself, even though they belong to it. 1199SEIU represents a large number of lower-waged workers like certified nursing assistants, and many also happen to be men and women of color. Not only do they encounter racism on the job, many say they encounter it as patients, too.

Couple the rapid development of the vaccine with the fact that health care workers were put  first in line to take it, and the context can feel experimental, even dangerous. Conspiracy theories that falsely link the recent death of Hank Aaron to the COVID vaccine are becoming widespread. American history, littered with examples of scientists being reckless with brown and Black lives — such as the infamous Tuskegee syphilis study —  can make misinformation about vaccines difficult to dispel.  An October survey from the Kaiser Family Foundation and The Undefeated found that Black adults who either work in health care or share a household with someone who does are much less likely to say definitively that they would get the vaccine. That mistrust exists because of U.S. history, said Benjamin. “They may not have been treated well when they go into the healthcare system,” he explained. “Based on race and socioeconomic status, they can see how others are treated or mistreated in systems.”

Workers “carry their life experiences with them as they make decisions around whether or not they get the vaccine,” he added.

That history has influenced 1199SEIU’s vaccination campaign, Seay said. “I’m a campaigner,” she said. “And what we know from trying to persuade folks to take action is that they are more likely to do it if someone like them asks them to.” Gresham, the union’s president, is Black; so is the chief medical officer of the union’s National Benefit Fund, Dr. Van Dunn. Members know and trust them, and the union hopes their voices will carry: Get the shot, stay alive, and keep your patients safe. Seay believes the campaign is working, too. “What we knew from our research is that about half of our members would get the vaccine when it was available to them. And about half of them have questions that they wanted to have answered, and weren’t ready to commit,” she said. Though the union didn’t release specific data to Intelligencer, Seay says vaccination rates are increasing as workers get the information they seek.

Only time can judge the benefits of 1199SEIU’s strategy. But the union’s emphasis on detailed, non-judgmental communication does conform to recent recommendations from the Centers for Disease Control and Prevention. “Focused” communications, “including messages regarding the documented safety and efficacy of authorized COVID-19 vaccines, might help improve vaccination acceptance and coverage In a recent report on vaccine hesitancy among staff in long-term care facilities,” CDC researchers observed in a recent report.

“Unions are very powerful in endorsing things to their members,” Benjamin pointed out. That may give 1199SEIU, and health care unions such as it, an edge in vaccinating workers.

Whether a health care worker fears a conspiracy theory or simply wants time to research the vaccines, understanding and respect go a long way. Once a health care worker understands how the vaccine really works, the decision is “almost a no-brainer,” Benjamin said. “But people have to be spoken to in a manner that is respectful, and gives them the opportunity to learn about the disease the vaccines prevent.” After a bit of research, Negron and Philip were able to overcome their reservations. They have a message now for other workers who are worried about the vaccine: Take it anyway. Philip, who once feared the side effects, said she had some body aches, “but nothing major.”

“I take great responsibility and great pride in my ability to be part of the solution,” Negron added. “The more of us that are immunized, the better chance we have of stopping the virus in its tracks.”