More hospitals poised to require COVID-19 vaccines

It’s “a trickle that will become a torrent,” Ashish Jha, dean at Brown University’s School of Public Health, tweeted.

More hospitals are likely to require employees receive a COVID-19 vaccine, experts said, to further protect the sick and vulnerable patients who rely on them for care.

A Houston-area hospital captured headlines after taking a firm stance on requiring vaccines that prevent severe illness of the coronavirus, which has killed more than 600,000 in the U.S. and ravaged the economy.

Houston Methodist employees who refused the vaccine were either terminated or resigned. A judge earlier this month sided with the hospital and tossed out an employee lawsuit that was seeking to block the mandated inoculation. The ruling may give other hospitals the green light to require the jab, and as more facilities put a similar policy in place, others are likely to follow, experts said.

It’s “a trickle that will become a torrent,” Ashish Jha, professor and dean at Brown University’s School of Public Health, posted Thursday on Twitter.

3 large health systems in Massachusetts to require all workers to be vaccinated.

Given the critical need to protect vulnerable patients, its critical all hospitals do this.

Leading systems will do it soon.

Laggards will get there eventually.

Joining the growing tide of vaccine mandates are a variety of systems and hospitals, including Mass General Brigham in Boston, BJC Healthcare in St. Louis and Inova Health System in Virginia.

Some of the nation’s largest health systems have yet to mandate the shot, including Kaiser Permanente and CommonSpirit Health.

“Vaccination will only be required for Kaiser Permanente employees if a state or county where we operate mandates the vaccine for health care workers,” the company said in an email.

The American Hospital Association continues to hear that a growing number of its members are requiring the vaccine, with some exemptions. However, many member hospitals are waiting until the FDA grants full approval, a time when more safety and efficacy data will be made available.

“Getting vaccinated is especially critical for health care professionals because they work with patients with underlying health conditions whose immune systems may be compromised,” AHA, which has not taken on stance on the requirement, said in a statement.

The mandates raise ethical questions, some say, pointing to the profession’s promise to “do no harm.”

Arthur Caplan, head of medical ethics at New York University School of Medicine, said the codes of ethics that doctors and nurses says to put patients first, do no harm and protect the vulnerable.

“Of course they should be vaccinated,” he said. “If they don’t want to get vaccinated, I think they’re in the wrong profession.”

The Equal Employment Opportunity Commission said employment law does not prohibit employers from requiring the jab, essentially giving the green light to employers to put incentives and requirements in place for their workers. The EEOC is the federal agency tasked with ensuring that workplaces do not discriminate.

Some states are going against the tide and signing legislation that bars vaccine mandates, including Florida. The city of San Francisco will require hospital employees and workers in high-risk settings to get the vaccine. San Francisco, like other employers and universities, will require all city workers get inoculated.

The differing policy stances across the country creates additional hurdles for corporations with a large footprint.

How Vaccine Refusal Could Prolong the Pandemic

Stephanie Nana, an evangelical Christian in Edmond, Okla., refused to get a Covid-19 vaccine because she believed it contained “aborted cell tissue.”

Nathan French, who leads a nondenominational ministry in Tacoma, Wash., said he received a divine message that God was the ultimate healer and deliverer: “The vaccine is not the savior.”

Lauri Armstrong, a Bible-believing nutritionist outside of Dallas, said she did not need the vaccine because God designed the body to heal itself, if given the right nutrients. More than that, she said, “It would be God’s will if I am here or if I am not here.”

The deeply held spiritual convictions or counterfactual arguments may vary. But across white evangelical America, reasons not to get vaccinated have spread as quickly as the virus that public health officials are hoping to overcome through herd immunity.

The opposition is rooted in a mix of religious faith and a longstanding wariness of mainstream science, and it is fueled by broader cultural distrust of institutions and gravitation to online conspiracy theories. The sheer size of the community poses a major problem for the country’s ability to recover from a pandemic that has resulted in the deaths of half a million Americans. And evangelical ideas and instincts have a way of spreading, even internationally.

There are about 41 million white evangelical adults in the U.S. About 45 percent said in late February that they would not get vaccinated against Covid-19, making them among the least likely demographic groups to do so, according to the Pew Research Center.

“If we can’t get a significant number of white evangelicals to come around on this, the pandemic is going to last much longer than it needs to,” said Jamie Aten, founder and executive director of the Humanitarian Disaster Institute at Wheaton College, an evangelical institution in Illinois.

As vaccines become more widely available, and as worrisome virus variants develop, the problem takes on new urgency. Significant numbers of Americans generally are resistant to getting vaccinated, but white evangelicals present unique challenges because of their complex web of moral, medical, and political objections. The challenge is further complicated by longstanding distrust between evangelicals and the scientific community.

“Would I say that all public health agencies have the information that they need to address their questions and concerns? Probably not,” said Dr. Julie Morita, the executive vice president of the Robert Wood Johnson Foundation and a former Chicago public health commissioner.

No clear data is available about vaccine hesitancy among evangelicals of other racial groups. But religious reasoning often spreads beyond white churches.

Many high-profile conservative pastors and institutional leaders have endorsed the vaccines. Franklin Graham told his 9.6 million Facebook followers that Jesus would advocate for vaccination. Pastor Robert Jeffress commended it from an anti-abortion perspective on Fox News. (“We talk about life inside the womb being a gift from God. Well, life outside the womb is a gift from God, too.”) The president of the Southern Baptist Convention, J.D. Greear, tweeted a photo of himself receiving a shot.

But other influential voices in the sprawling, trans-denominational movement, especially those who have gained their stature through media fame, have sown fears. Gene Bailey, the host of a prophecy-focused talk show on the Victory Channel, warned his audience in March that the government and “globalist entities” will “use bayonets and prisons to force a needle into your arm.” In a now-deleted TikTok post from an evangelical influencer’s account that has more than 900,000 followers, she dramatized being killed by authorities for refusing the vaccine.

Dr. Simone Gold, a prominent Covid-19 skeptic who was charged with violent entry and disorderly conduct in the Jan. 6 Capitol siege, told an evangelical congregation in Florida that they were in danger of being “coerced into taking an experimental biological agent.”

The evangelical radio host Eric Metaxas wrote “Don’t get the vaccine” in a tweet on March 28 that has since been deleted. “Pass it on,” he wrote.

Some evangelicals believe that any Covid restrictions — including mask mandates and restrictions on in-person church worship — constitute oppression.

And some have been energized by what they see as a battle between faith and fear, and freedom and persecution.

Fear is the motivating power behind all of this, and fear is the opposite of who God is,” said Teresa Beukers, who travels throughout California in a motor home. “I violently oppose fear.”

Ms. Beukers foresees severe political and social consequences for resisting the vaccine, but she is determined to do so. She quit a job at Trader Joe’s when the company insisted that she wear a mask at work. Her son, she said, was kicked off his community college football team for refusing Covid testing protocols.

“Go ahead and throw us in the lions’ den, go ahead and throw us in the furnace,” she said, referring to two biblical stories in which God’s people miraculously survive persecution after refusing to submit to temporal powers.

Jesus, she added, broke ritual purity laws by interacting with lepers. “We can compare that to people who are unvaccinated,” she said. “If they get pushed out, they’ll need to live in their own colonies.”

One widespread concern among evangelicals is the vaccines’ ties to abortion. In reality, the connection is remote: Some of the vaccines were developed and tested using cells derived from the fetal tissue of elective abortions that took place decades ago.

The vaccines do not include fetal tissue, and no additional abortions are required to manufacture them. Still, the kernel of a connection has metastasized online into false rumors about human remains or fetal DNA being an ingredient in the vaccines.

Some evangelicals see the vaccine as a redemptive outcome for the original aborted fetus.

Some Catholic bishops have expressed concerns about the abortion link, too. But the Vatican has concluded the vaccines are “morally acceptable,” and has emphasized the immediate danger posed by the virus. Just 22 percent of Catholics in America say they will not get the vaccine, less than half the share of white evangelicals who say that.

White evangelicals who do not plan to get vaccinated sometimes say they see no need, because they do not feel at risk. Rates of Covid-19 death have been about twice as high for Black, Hispanic, and Native Americans as for white Americans.

White pastors have largely remained quiet. That’s in part because the wariness among white conservative Christians is not just medical, but also political. If white pastors encourage vaccination directly, said Dr. Aten, “there are people in the pews where you’ve just attacked their political party, and maybe their whole worldview.”

Dr. Morita, of the Robert Wood Johnson Foundation, said the method to reach white evangelicals is similar to building vaccine confidence in other groups: Listen to their concerns and questions, and then provide information that they can understand from people they trust.

But a public education campaign alone may not be enough.

There has been a “sea change” over the past century in how evangelical Christians see science, a change rooted largely in the debates over evolution and the secularization of the academy, said Elaine Ecklund, professor of sociology and director of the Religion and Public Life Program at Rice University.

There are two parts to the problem, she said: The scientific community has not been as friendly toward evangelicals, and the religious community has not encouraged followers to pursue careers in science.

Distrust of scientists has become part of cultural identity, of what it means to be white and evangelical in America, she said.

For slightly different reasons, the distrust is sometimes shared by Asian, Hispanic and Black Christians, who are skeptical that hospitals and medical professionals will be sensitive to their concerns, Dr. Ecklund said.

“We are seeing some of the implications of the inequalities in science,” she said. “This is an enormous warning of the fact that we do not have a more diverse scientific work force, religiously and racially.”

Among evangelicals, Pentecostal and charismatic Christians may be particularly wary of the vaccine, in part because their tradition historically emphasizes divine health and miraculous healing in ways that can rival traditional medicine, said Erica Ramirez, a scholar of Pentecostalism and director of applied research at Auburn Seminary. Charismatic churches also attract significant shares of Black and Hispanic Christians.

Dr. Ramirez compares modern Pentecostalism to Gwyneth Paltrow’s Goop, with the brand’s emphasis on “wellness” and “energy” that infuriates some scientists: “It’s extra-medical,” she said. “It’s not anti-medical, but it decenters medicine.”

The Centers for Disease Control and Prevention and Dr. Anthony Fauci are not going to be able to persuade evangelicals, according to Curtis Chang, a consulting professor at Duke Divinity School who is leading an outreach project to educate evangelicals about the vaccine.

The project includes a series of short, shareable videos for pastors, answering questions like “How can Christians spot fake news on the vaccine?” and “Is the vaccine the Mark of the Beast?” The latter refers to an apocalyptic theory that the AntiChrist will force his sign onto everyone at the end of the world.

These are questions that secular public health entities are not equipped to answer, he said. “The even deeper problem is, the white evangelicals aren’t even on their screen.”

Mr. Chang said he recently spoke with a colleague in Uganda whose hospital had received 5,000 vaccine doses, but had only been able to administer about 400, because of the hesitancy of the heavily evangelical population.

“How American evangelicals think, write, feel about issues quickly replicates throughout the entire world,” he said.

At this critical moment, even pastors struggle to know how to reach their flocks. Joel Rainey, who leads Covenant Church in Shepherdstown, W.Va., said several colleagues were forced out of their churches after promoting health and vaccination guidelines.

Politics has increasingly been shaping faith among white evangelicals, rather than the other way around, he said. Pastors’ influence on their churches is decreasing. “They get their people for one hour, and Sean Hannity gets them for the next 20,” he said.

Mr. Rainey helped his own Southern Baptist congregation get ahead of false information by publicly interviewing medical experts — a retired colonel specializing in infectious disease, a church member who is a Walter Reed logistics management analyst, and a church elder who is a nurse for the Department of Veterans Affairs.

On the worship stage, in front of the praise band’s drum set, he asked them “all of the questions that a follower of Jesus might have,” he said later.

“It is necessary for pastors to instruct their people that we don’t always have to be adversaries with the culture around us,” he said. “We believe Jesus died for those people, so why in the world would we see them as adversaries?”

The barriers to vaccine passports

https://www.axios.com/barriers-coronavirus-vaccine-passport-ee5ae689-c9e2-4306-9671-0af28bf21445.html

Vaccine passports could become available soon to help people resume their lives — but they face numerous scientific, social and political barriers to being accepted.

The big picture: Reliable and accessible proof of vaccine-induced protection from the novel coronavirus could speed international travel and economic reopening, but obstacles to its wide-scale adoption are so great it may never fully arrive.

Driving the news: The secure digital identity app CLEAR and CommonPass, a health app that lets users access vaccination records and COVID-19 test results, will be working together to offer a vaccine passport service, my Axios colleague Erica Pandey reports.

  • The news comes as a growing number of countries and companies are talking up plans to introduce similar vaccine passports that could help the protected return to normal life and travel as soon as possible.
  • To restart the economy, to save certain industries, I think you need a solution like this,” Eric Piscini, a vice president at IBM who oversaw the development of the company’s new health passport app, told the New York Times.

Yes, but: There are numerous health, ethical and operational questions that need to be resolved before vaccine passports could become an effective part of daily life.

Health: Medical experts still don’t fully know how effective vaccinations — or exposure to the virus — are at preventing onward transmission of COVID-19.

  • While the CDC is set to soon release new guidance around social activity for fully vaccinated people, current recommendations still call for them to keep wearing masks and practicing social distancing.
  • Until it’s clear that vaccination effectively prevents transmission, there’s a limit to how useful any vaccine passport can be for public health — especially if emerging variants render some vaccines less protective.
  • The utility of a vaccine passport is only as good as the evidence of how long the immunity lasts,” David Salisbury, an associate fellow at think tank Chatham House, told Bloomberg. “You could find yourself with a stamp in your passport that lasts longer than the antibodies in your blood.”

Ethical: The most obvious use case for vaccine passports is for international travel, which has been crippled by onerous quarantine restrictions. But such a system risks locking out billions of people who are unable or unwilling to get the vaccine.

  • The EU has been discussing the creation of a vaccine passport, with tourism-dependent countries like Greece leading the charge. But Germany and France — where the vaccine rollout has been low and hesitancy is high — have reservations, and any such system looks to be months away.
  • A bigger ethical concern is the many people in developing countries who may not get access to vaccines of any sort for months or even years while rich nations hoard supplies.
  • And if vaccine passports are used not just for international travel but to allow people to work and engage in social life domestically, they could create cripplingly unequal barriers that might paradoxically reinforce vaccine hesitancy.

Operational: Passports for international travel are regulated by governments and have decades of history behind them, but there’s no such unified system for vaccine passports, which are being introduced by governments and businesses with different standards, making them a target for fraud.

  • The U.S. in particular has a decentralized medical system that can make it difficult for people to easily access their health care records, especially if they lack digital literacy.
  • “I can pretty much 100% guarantee that fraud is going to occur,” says Jane Lee, a trust and safety architect at the cybersecurity company Sift. “We will have a lot of bad actors where they pretend to offer a service that will provide some sort of vaccination passport, but it’s really a phishing campaign.”

Be smart: None of these obstacles are insurmountable on their own. But as we saw with the failures of digital contact tracing, just because a technological solution exists doesn’t mean it will be effective or adopted by the public.

  • “There’s a huge motivation to make this work socially,” says Kevin Trilli, chief product officer at Onfido, an identification verification company. “But there’s a lot of governmental issues that are going to really make the system difficult to implement.”
  • There’s a time pressure at work here as well, especially in the U.S, where vaccination rates have picked up. The more people who are vaccinated, the less value there will be in creating a complex system to sift the protected from the unprotected.

The bottom line: Some form of vaccine visas will likely be introduced for international travel, but it seems unlikely they’ll become a passport to resuming normal life.

Los Angeles hospitals brace for care rationing

Rising Covid cases means Americans may face health care rationing. Here's  how they view that.

Several hospitals in Los Angeles County are preparing for the possibility of restrategizing care delivery in the coming weeks amid growing COVID-19 hospitalizations, according to the Los Angeles Times.

Los Angeles County reported 6,018 COVID-19 hospitalizations Dec. 20 — a 2.5 percent increase from the day prior — with 1,198 patients in ICUs, according to the state’s data dashboard. Statewide, 17,750 patients are hospitalized with COVID-19, 3,710 of them in ICUs. 

The LA Times obtained a document recently circulated among physicians at the four county-run hospitals that outlines resource allocation in crisis situations. The guidelines call for physicians to save as many patients as possible versus trying everything to save a patient, meaning those less likely to survive will not receive the level of care they would have otherwise. L.A. County Health Services Director Christina Ghaly, MD, told the LA Times that the guidelines were not in place as of Friday night.

California activated its “mass fatality” program last week, which coordinates mutual aid across several government agencies when more deaths take place in a period of time than can be handled by local coroner or medical emergency personnel, NPR reports. 

Nearly all of the state is under stay-at-home orders, with residents prohibited from gathering with anyone outside their immediate household.

“I have yet to see any clear signals that things are slowing down, and I’m very concerned about the next two months,” Timothy Brewer, MD, an epidemiologist with UCLA Health, told the LA Times. He said UCLA Health is scheduling several infectious disease specialists to be on call at any time, and the biggest issue is that hospitals may quickly run out of providers who can administer ICU-level care.