This article was medically reviewed by Dr. Ronald Nahass.
A leading NJ healthcare provider, RWJBarnabas Health (RWJBH), has joined many health organizations, universities, and private industries in mandating the COVID-19 vaccination for its staff. In this article, Dr. Ronald Nahass, President of New Jersey based infectious disease practice ID Care, addresses frequently asked questions around this decision.
Why are Many Organizations Moving Toward Mandatory Vaccination?
Mandatory vaccination provides organizations the best opportunity to reliably ensure the safety of their staff and visitors. For healthcare workers who may be intensely exposed to COVID-19 during their work, this has even more importance.
Hospitals need to maintain a healthy work force to care for the sick and injured. It is now clear that vaccination provides the best opportunity to protect against serious illness, even with the variants currently circulating. Healthcare workers have a far greater risk that they will expose compromised and vulnerable patients to COVID-19 should they have an asymptomatic infection. Not only does the vaccination protect against serious illness but it dramatically reduces transmissibility of the virus.
As healthcare workers, we have an obligation to protect patients from contagious disease. Vaccination for contagious disease is one important part of the protection we offer patients. Historically, this type of mandate has a long precedent in healthcare with requirements for measles, mumps, rubella, chickenpox, and influenza vaccination as a condition of employment. A requirement for COVID-19 vaccination is consistent with this standard and precedent.
Is Mandatory Vaccination Legal?
Many questions or concerns about the legality of mandatory vaccination requirements have been raised. The legality of mandatory vaccination for COVID-19 and other vaccines was ruled as legal in a Federal District Court in Texas in a suit brought against a large health system.
The US Equal Employment Opportunity Commission (EEOC) has written that proof of vaccination can be required by an employer as well, providing additional support for this approach. Another consideration discussed in this matter is the question of public health versus individual rights, a challenging topic indeed.
Generally, societies and governments have used the public health imperative to implement mandatory public health practices that have the potential to protect others. Some examples include mandatory quarantine for tuberculosis or mandatory measles and polio vaccine requirements for school attendance. In the context of the history of vaccine related requirements, there have been several examples where requirements for vaccination for the public good were implemented.
How Well Does the Vaccine Do its Job in an Organization?
Recently, on July 23, 2021, a wonderful study done in the Philadelphia school district was published which demonstrated the amazing effectiveness of the vaccine for a large organization. Following school reopening in Philadelphia County, Pennsylvania, on March 21, 2021, weekly point-of-care SARS-CoV-2 testing identified a 95% lower percentage of positive test results among school staff members who had received both doses of the Pfizer-BioNtech vaccine compared with those among unvaccinated staff members.
These results occurred when the city’s daily COVID-19 incidence was 29-33 cases per 100,000 population, and approximately 40% of strains sequenced from the region were the B.1.1.7 (Alpha) lineage.
Why Does the COVID-19 Vaccine not Have Full FDA Approval?
While the COVID-19 vaccine is still only authorized for emergency use, it is not experimental at this point. The experimental studies have been completed and finalized. The FDA is in the process of reviewing the detailed data of the vaccine use in the real world over a longer period as required for full approval. They must follow the usual rigorous approach. It simply takes time for the data to be collected, formatted, and reviewed. Pfizer has submitted their full data set. Over the last seven months, Moderna and Pfizer have both been collecting, analyzing, and submitting real world data to complete their submission to the FDA to gain full approval.
Any time a potential side effect is noted, the public has been immediately notified as seen with the blood clotting, Guillain Barre, and myocarditis side effects mentioned above. None of the side effects have risen to a high enough frequency to prevent full approval. Full approval for Pfizer is expected in the next couple of months based on an expedited review process.
How Safe is the COVID-19 Vaccine?
At this point, the good news for all healthcare workers is that the safety of the vaccine continues to support its widespread use. Over 2 billion doses have been administered worldwide. Here in the U.S., almost 200 million people have received at least one dose of a SARS CoV2 vaccine. Although some have a vigorous vaccine response with achiness and fever that can result in a day of missed work, most people tolerate the vaccine fine and recovery for those with vigorous responses is rapid as with other vaccines. Serious side effects are very rare. Those serious concerns include blood clotting abnormalities and Guillain Barre in a small number of patients after the JNJ vaccine, and a very small number of cases of myocarditis, inflammation of the heart muscle, that resolves quickly with no subsequent condition in young men receiving an mRNA vaccine. These serious consequences are exceedingly rare, and when weighed against the consequences of COVID-19, are diminishingly small.
Could the COVID-19 Vaccine Affect Fertility or Pregnancy?
There are valid questions surrounding the COVID-19 vaccine and the impact on fertility or pregnancy. Now that the vaccine has been given to millions of people, we continue to gain experience with fertility and pregnancy concerns. Several publications have reported the experience with pregnancy and no serious adverse effect on the mother or unborn child have been reported. Additionally, no concerns for infertility have been identified despite the very large number of both men and women of childbearing years who have been vaccinated.
As the highly transmissible Delta variant makes its way through the susceptible population, we have a much greater concern for these issues from getting COVID-19. COVID-19 in pregnancy poses greater risk to the mom and unborn child. We need to do all we can to keep pregnant moms from getting COVID-19. Since this variant is so transmissible, we are now seeing two different experiences with COVID-19; the unvaccinated are going to get infected and put their pregnancy at risk.
Is the Israeli Study Suggesting the COVID-19 Vaccine may not be Working Against the Delta Variant Accurate?
That study, which has only been reported in the newspapers at this time, suggested the vaccine is only 39% effective at reducing the risk of infection and 40% effective at reducing the risk of symptomatic disease during a period when the Delta variant dominated cases in Israel, according to the country’s Health Ministry. The vaccine was 91% effective at preventing severe illness in the same period between June 20 and July 17, 2021, the ministry said.
However, a publication in the New England Journal of Medicine on the results of vaccination in the UK, noted that the Pfizer vaccine, which is the same one as used in Israel, had an effectiveness of two doses that was 93.7% among persons with the Alpha variant and 88.0% among those with the Delta variant. The results in Israel will need to be validated and compared to the UK experience once they are published.
Do You Still Need a Vaccine if you Already had COVID-19?
If you were previously infected, you cannot assume you are protected. We have no test to measure protection particularly against the various variants. You may be protected, but you also may not be. A recent study from the Cleveland Clinic suggests individuals with prior infection will be protected for future infection, but duration of protection and completeness of protection for variants is not clear. Given the safety of the vaccine, uncertainty about the level of protection and widespread dissemination of the variant, it is recommended that people with prior infection get vaccinated.
What is the Bottom Line of the Delta Variant?
The Delta variant is extraordinarily contagious and, if you are not vaccinated, you will likely get infected with this variant over the next several months and be at risk for serious illness. There will be almost no way to escape being infected. This has to do with how contagious the Delta variant is.
Infectious diseases experts use the R0 value (pronounced “R naught”), a mathematical term that indicates how contagious an infectious disease is and how quickly it reproduces when transmitted to new people. The R0 value shows how many people are likely to be infected when exposed to a person infected with COVID-19, and the data is concerning. While the initial COVID-19 virus has an R0 of 2.3-2.7 (one infected person is likely to infect 2.3 to 2.7 unaware people), the Alpha (United Kingdom variant) has an R0 of 4-5, and the Delta (Indian) variant has an R0 of 5-8. These numbers for the Delta variant make it among the most contagious viruses known to man. It is more contagious than the virus that caused the great flu pandemic of 1918.
Here is What you Need to Know About COVID-19 Vaccination to be Protected:
- If you are not vaccinated, you are almost certainly going to be infected with the Delta variant.
- COVID-19 infection is serious and will potentially put your life at risk.
- Survivors of COVID-19 have a 20-30% risk of developing long COVID-19 regardless of severity.
- COVID-19 infection is a particularly serious illness in pregnancy and will put the pregnancy at risk.
- Given the contagiousness of the Delta variant, we are nowhere near herd immunity.
- The vaccine is safe. Certainly, as safe as most other vaccines we currently receive.
- Furthermore, COVID-19, particularly the Delta variant, poses far more risk to individuals and the community.
- Vaccine requirements have a long history in the healthcare field.
- Don’t delay, get vaccinated now. It will cost nothing. It will protect you, your family, your colleagues, your patients, and your community. We are in this together and we need to do this together.
About ID Care
Nationally recognized for infectious disease specialty services, ID Care provides infectious disease care, wound care, infusion care and travel care across 10 convenient outpatient locations throughout New Jersey. It also serves over 130 hospitals and healthcare facilities throughout New Jersey, providing vital care to ensure the health of healthcare workers and the patients they serve. If you have any questions on ID Care services or would like to consult with an expert on designing or implementing a customized program for your facility, please call 908-281-0610 or visit ID Care Partners today.