Vaccine Refusal among US Health Care Workers

September 23, 2021

By LaTonya J. Trotter

As the US faces another covid-19 surge, the slow uptake of vaccinations is thought to be a primary explanatory factor. According to the CDC, only 66% of adults were fully vaccinated as of late September. But what has been particularly alarming to many, is the number of health care workers who remain unvaccinated.

As of July 2021, 73% of all health care workers report being vaccinated. There is, however, notable variation. Survey data suggests that 96% of physicians are fully vaccinated, compared to 83% of Registered Nurses (RNs) But among nursing assistants who worked in long-term care facilities, that rate falls to 49%.  In some ways, this variation is unsurprising; in the general population, those with lower levels of education have lower rates of vaccination. But this relationship is particularly worrying among health care workers as education is also associated with time at the bedside: those at the greatest risk of both contracting and spreading the virus are the least likely to be vaccinated.

The impact of this phenomenon on the medical workplace is unclear. There is evidence that many who were “vaccine hesitant” early in the pandemic, have since become vaccinated. But the same data suggests that those who have held out this long are better understood as “vaccine refusers” in that they self-report that there is little that can be done to change their minds. We may see, however, if behavior can change without a change in belief. In September, US President Joseph Biden announced a vaccine mandate rule for all employers with more than 100 employers—a mandate that covers the places where most health care workers work.

There are open questions about whether this mandate will negatively impact the healthcare workforce. Most health care organizations were already struggling with staffing. While it is less likely that physicians, nurse practitioners, and others with expensive educational investments will leave their occupations because of such mandates, they may drive out those in lower-wage sectors of the health care labor force, including certified nursing assistants, home health care aides, long-term care workers, and those who work in under-resourced organizations.

There is little question that allowing health care workers to remain unvaccinated is at cross purposes with ending the pandemic. However, for some, such mandates may be the proverbial straw that breaks their attachment to the health care work force. Many health care organizations are already facing this surge with fewer workers than they had last winter. Without its workers, the US health care system is in danger of collapse.