When Pam Goble first heard that President Biden was mandating the COVID-19 vaccine for health care workers, she had one thought: It's about time.
Goble is owner and CEO of Ability HomeCare, a pediatric home health care agency serving 900 children in San Antonio, Texas.
Of her 261 nurses and therapists, 56 have declined to get the vaccine.
"I am one of those people that really feels everybody should have their choice," says Goble. She did not impose her own vaccine mandate even as the delta variant drove a spike in COVID-19 cases among her employees and the families they serve.
Now she's concerned that her unvaccinated employees may refuse to comply with the federal mandate once it's implemented later this fall.
"We would have to let people go," she says. "I worry if our patients, who are medically fragile children, are going to get the care they need."
Biden's mandate covers 17 million health care workers
Health care workers had priority access to the COVID-19 vaccine back in December 2020, but nine months later, many are still reluctant to get the shots. Vaccination rates remain low in some states and among some subgroups of health care workers such as nursing assistants. As part of his push to get more Americans vaccinated, Biden has essentially told 17 million health care workers: Get vaccinated or get out. He has not offered them the testing option he's given workers in most other industries.
Details about how the federal vaccine mandate will be enforced have yet to be released, but already protests have become regular events outside hospitals, and employers are warning they could see large numbers of workers quit just when they're needed the most.
It's hard to predict how many people will actually quit their jobs over the vaccine mandate. In June, after a federal judge dismissed a lawsuit brought by health care workers at Houston Methodist Hospital over its vaccine mandate, more than 150 workers quit or were fired.
Lewis County General Hospital in upstate New York said it would stop delivering babies this month after six people in the maternity department quit over New York's vaccine mandate.
In Maine, where the governor announced a vaccine mandate for health care workers in mid-August, hospitals are so far reporting only a handful of resignations, but enforcement of the mandate is still more than a month away.
Losing even one or two workers would be a problem
"I can't afford to lose anyone," says Ted LeNeave, CEO of Accura HealthCare, which operates 34 nursing homes and assisted living facilities in Iowa, Minnesota, Nebraska and South Dakota. Because of staffing shortages, they've had to limit admissions, turning down patients coming from hospitals.
With about 1,000 of his employees — 38% of his workforce — unvaccinated, LeNeave is calling on the federal government to provide a testing option for health care workers. He's proposed that those who remain unvaccinated would undergo regular testing and wear full PPE, arguing that it's a safer alternative to losing a lot of workers.
"I just don't see how I can lay off a thousand people," says LeNeave. "I'd have no one to take care of the patients, and there's nowhere to send the patients."
LeNeave has offered his employees incentives to get vaccinated, including the chance to win $1,000 in a lottery, but he says many remain fearful. Some cite false claims about the vaccines' effect on fertility while others want to wait a year or two to see if any problems arise. And then there are those who are against it, period.
Health care workers may opt to change professions
He expects many will change professions to avoid getting the shots. Certified nursing assistants, who bathe, feed and groom nursing home residents, are among the lowest paid workers in the U.S. There are plenty of other options for those who want out.
"Especially with our facilities in rural areas, we could lose nurses to go work at Casey's or Kum & Go" gas station convenient stores. In those jobs, workers would have an option to get tested rather than be vaccinated.
In Texas, Goble is baffled that this far into the pandemic, and with more than a thousand people dying from COVID-19 every day, the vaccines remain so politicized.
"I keep hearing this anti-vaccine argument about freedom," she says. "But I want my freedom to live out from under a pandemic. And I want the children and families we serve to have that right too."
NOEL KING, HOST:
Data shows that health care workers are some of the people most skeptical of the COVID-19 vaccine. President Biden's mandate says they have to get vaccinated. In most other industries, workers have the option to get tested instead of getting the vaccine but not in health care. And now health care employers are worried that they could lose their workers right when they need them most. Here's NPR's Andrea Hsu.
ANDREA HSU, BYLINE: When President Biden announced his sweeping vaccine requirements earlier this month, he summed up the case for the health care mandate this way.
(SOUNDBITE OF ARCHIVED RECORDING)
PRESIDENT JOE BIDEN: If you're seeking care at a health facility, you should be able to know that the people treating you are vaccinated - simple, straightforward, period.
HSU: Actually, not so simple.
(SOUNDBITE OF PROTEST)
UNIDENTIFIED PERSON #1: Stop the mandate.
UNIDENTIFIED PERSON #2: We don't police...
UNIDENTIFIED PERSON #3: No mandates.
HSU: Across the country, a vocal minority of health care workers are protesting. And in some states, vaccination rates in health care remain low. Pam Goble is CEO and owner of Ability HomeCare in San Antonio, Texas. Her company provides in-home therapy and nursing for children.
PAM GOBLE: My director of nursing, who did not get the vaccine, was out for a month. She nearly died. And she's 32 years old.
HSU: Now, a lot of Goble's workers did get vaccinated over the summer, but about 20% still say they don't want to. She's baffled by that when a couple thousand people are dying of COVID every day.
GOBLE: I really do think, how much death is enough before this debate is over?
HSU: But this is Texas. Pam Goble did not want to force anyone to get the shots.
GOBLE: I didn't. You know, I am one of those people that really feels everybody should have their choice. But it was getting to the point where, like, somebody needed to stand and say, hey, this is what we're going to do.
HSU: She was relieved when Biden stepped in and did exactly that. Now, though, Goble is worried about what's going to happen if the 56 unvaccinated nurses and therapists on her staff refuse to comply. She's already short-staffed.
In Iowa, Ted LeNeave shares her concerns. He's CEO of Accura HealthCare. They operate 34 nursing homes and assisted living facilities.
TED LENEAVE: We've been trying to get everyone vaccinated. I'm pro-vaccine.
HSU: But 38% of his workforce is not. Some are fearful, citing false claims about the vaccine's effects on fertility. Some want to wait a year or two to see if any problems crop up. And some, LeNeave says, are just against it, period. Add it all up, and he's got a thousand workers who aren't vaccinated at a time when he can't afford to lose even one or two.
LENEAVE: Actually, I need more people. There are times that the hospital will want us to take someone, and we just don't have the staff to do it.
HSU: So he's written to the federal government to ask for a test-out health option for health care workers. Those who remain unvaccinated would get tested regularly, as many are now, and wear full PPE. He argues that would be safer than losing a whole lot of staff.
LENEAVE: Especially with a lot of our facilities in rural areas, we could lose nurses to go work at Casey's or Kum & Go.
HSU: Gas station convenience stores.
LENEAVE: They'll just say, I'm that serious about not getting vaccinated.
HSU: LeNeave is expecting the final rule on vaccines for health care workers to come out in mid-October.
LENEAVE: If we don't get a test-out option and the date comes and I have to lay off a thousand people, I can't do that.
HSU: He says he has to put the lives of his residents first. Andrea Hsu, NPR News. Transcript provided by NPR, Copyright NPR.