Question: I have read news reports saying that 30 to 40 per cent of the staff at some hospitals have not received a COVID-19 vaccination even though they are all eligible for the shot. Surely, they are putting patients in jeopardy. Why can’t hospitals insist that health-care workers be vaccinated? If the employees refuse, they should be put on unpaid leave.
Answer: It’s true that unvaccinated health-care workers may pose an increased risk to others. If they become infected, either at work or in the community, they could spread the coronavirus to their fellow employees or vulnerable patients.
But force or coercion is seldom an effective way of bringing people onside. And barring unvaccinated staff from a hospital would only put more pressure on an overburdened health-care system that is already short of health-care workers.
“In the middle of the third wave of the pandemic, human resources are a major concern because we have to care for a record number of COVID patients,” says Jerome Leis, medical director of infection prevention and control at Sunnybrook Health Sciences Centre in Toronto.
So, Leis and his colleagues at several other Toronto hospitals are banking on another strategy to boost staff vaccination rates. A key component involves online educational modules that will provide staff with evidence-based data and specific information to dispel vaccine myths.
It may seem odd that people who work in hospitals – at the epicentre of the deadly pandemic – would need to be convinced that vaccines are beneficial.
But it’s important to keep in mind that a hospital requires more than just front-line nurses and doctors, says Kevin Katz, medical director of infection prevention and control at North York General Hospital. Many people are needed for cleaning, maintenance, food services, administration and other essential jobs.
“The rollout of vaccines in Canada has been fraught with problems on the information side. Our staff are members of the public as well. And a lot of people have questions in their minds about the vaccines,” adds Katz.
Leis is convinced that the online educational module will encourage more staff to get the COVID-19 shot because a similar approach significantly increased influenza vaccine uptake. “Even before the COVID-19 pandemic, we spent a number of years trying to improve our flu vaccine rates among staff.”
He notes that in the 2018-2019 flu season, about 58 per cent of staff at his hospital stepped forward for an influenza vaccine. When a mandatory online educational course was introduced in 2019-2020, the staff vaccination rate shot up to 74 per cent. And, in the context of the pandemic’s third wave, he is expecting even better results with a COVID-19 vaccine education module.
“Most health-care workers are actually not opposed to being vaccinated,” he says, “There’s a fraction that may be a little bit ambivalent and they might be deferring their decision to get a shot.”
But a mandatory education course “acts as a nudge for staff who have not gotten around to being vaccinated to go and do so,” says Leis.
Staff who choose to be vaccinated, or those who can produce proof they need a medical exemption from the shot, don’t have to do the course. The interactive module, which requires the learner to correctly answer a series of questions based on the content of the course, usually takes about 15 minutes to complete.
Those who finish the module and still don’t want to be vaccinated must then sign a form confirming that they have chosen to forgo the inoculation.
Leis said Sunnybrook unveiled its module on April 5 and staff have until April 30 to either book a COVID-19 vaccine appointment or take the online course. “There’s definitely been a spike in vaccine appointments since we announced this policy,” he notes.
Meanwhile, plans are under way to introduce vaccine educational modules at two other Toronto medical centres – North York General and Michael Garron Hospital (MGH). Several other Ontario hospitals are contemplating the same strategy, says Leis.
Jeff Powis, medical director of infection prevention and control at MGH, says a high percentage of the hospital’s physicians and those who work in direct contact with COVID-19 patients have already rolled up their sleeves for the shot. But uptake has been lower among certain groups, including those from racialized communities and among women of childbearing age –vaccine-hesitancy trends that are also observed in the general public.
“I think it’s our duty to ensure everyone on staff has an opportunity to make an informed decision,” says Powis, adding that the education modules should help contribute to that goal.
People need to freely choose to be vaccinated, he says. “We need to motivate these individuals to work as part of a team,” he says. And “forcing them to do something” would be counterproductive in the long run.