The leader of the nation’s largest lobbying and trade group for nursing homes challenged state governors to facilitate the vaccination of all residents and staff against COVID-19 by March 1, but the organization stopped short of recommending that operators require workers to take the vaccine.
“If the governors and public health officials are able to do this, we will save tens of thousands of lives in these facilities,” American Health Care Association (AHCA) CEO Mark Parkinson said during a Monday press conference.
Though the Centers for Disease Control & Prevention (CDC) last week formally voted to place health care workers and long-term care residents at the front of the line as soon as a novel coronavirus vaccine receives emergency approval, it’s up to state governors to direct the precious supplies of shots to the right places.
The vaccines racing toward approval require a pair of shots to achieve full immunity; Parkinson’s March 1 deadline applies to both interventions.
“If we can get this done in the next 60 days, we can cut the overall COVID death rate by 40% — just by getting those initial four or five million doses out to that very important population,” Parkinson said.
The speed with which drug companies developed the vaccine has raised concerns about its safety and efficacy, with skepticism even among the frontline health workers who have seen so many of their patients and coworkers succumb to COVID-19.
“My concern is not necessarily the vaccine, if it’s proven safe,” Lori Porter, CEO of the National Association of Health Care Assistants, told SNN earlier this month. “My fear is that if we don’t educate them, if we allow the facilities to provide the education on the vaccine, there is a trust issue. CNAs do not trust their leaders.”
Based on informal polling of the group’s members, which include thousands of certified nursing assistants (CNAs) across the country, Porter said there’s “a lot of anxiety” around the vaccine for the health care professionals who will likely need it most.
“They don’t believe there was time to develop a proper vaccine,” she said. “They don’t want to be guinea pigs. Even one said: I’ll take it if they’ll [the facility] buy life insurance on me, but I’m not going to take it and die poor.”
AHCA currently does not have a formal opinion on mandatory vaccines for facility employees, Parkinson said Monday; instead, the organization hopes that the allure of resident safety and a return to normalcy will prompt both staffers and residents to sign up voluntarily.
In general, health care employers can require vaccination as a prerequisite for employment, with a long-time precedent for the more familiar annual flu shot. But workers also have the right to object on personal health or religious grounds, and the exact legality of a blanket vaccine mandate — especially during an unprecedented public health crisis — remains hazy.
“Our hope is that we get widespread acceptance of the vaccine — but if we don’t, I assure you that our organization, as well as individual operators, will be analyzing whether or not they can mandate the vaccine,” Parkinson said. “We’re just hoping that we don’t have to go there.”
The Department of Health and Human Services (HHS) has contracted with CVS Health and Walgreens to handle the complex logistics of vaccine administration in nursing homes, from distribution to cold storage to eventual public data reporting requirements.
The exact vaccine distribution method for staff members will likely vary by state, however, with workers potentially able to access the shots before they become available to residents at local health clinics or retail pharmacies.
The efficacy of the vaccine for older people, particularly long-term nursing home residents with multiple co-morbidities, has also been questioned in the lead-up to emergency approval.
Dr. David Gifford, AHCA’s chief medical officer, tried to allay those fears by noting that he told his own parents to receive the vaccine as soon as possible given the extremely high COVID-19 mortality rates among the elderly.
“As a physician, and as a child of parents who are in their 80s, I am not worried at all about recommending this vaccine to someone in our group out there,” Gifford said.
The final vaccination timeline will depend heavily on the Food and Drug Administration (FDA), which must provide a formal Emergency Use Authorization (EUA) before doses can hit the streets.
Based on current information, Gifford expects clinics to spring up in nursing homes by the last two weeks of December, though he cautioned that delays in FDA approval could result in a longer window.
AHCA’s vaccine challenge comes as infections and deaths in nursing homes continue to surge past the marks seen during the earliest days of the pandemic: In April, for example, the grim record was about 10,000 new cases in long-term care facilities each week.
That number now sits at about 18,000, Parkinson noted.
“I wouldn’t be surprised if we soon see about 20,000 cases every single week in these facilities — twice as bad as the worst of the peaks back last spring,” he said.