The largest healthcare providers in Western North Carolina, including Mission Hospital in Asheville, confirmed this week that they are not requiring doctors, nurses, volunteers, or other hospital staff to be vaccinated against the COVID-19 virus despite a resurgence of infections and hospitalizations.
Most of the other major hospital systems in the state have made full vaccinations mandatory, citing staff and patient safety as a highly contagious COVID-19 variant spreads nationwide, almost entirely among people who have not been vaccinated or are only partly vaccinated.
Hospital administrators and clinical leaders say they agree that vaccinations represent the most effective way to stop the pandemic that has killed more than 600,000 Americans, including hundreds of people in Asheville and surrounding communities.
Few people are more familiar with the impact of the COVID-19 pandemic than hospital workers. Even so, hospital administrators in Western North Carolina — where science and politics are not always compatible — said nurses, nursing assistants and other hospital workers might quit their jobs at already understaffed health facilities rather than submit to mandatory COVID vaccinations. To fill vacant positions, hospitals typically must pay premium salaries for temporary replacement doctors and nurses.
The tensions between medical science and politics, and between hospital economics and patient and staff safety, are evident in the mountain region of the state, where anti-masking and anti-vaccination sentiment is common.
As of Wednesday, “almost 56 percent of Mission Health colleagues and 67 percent of our clinical providers are fully vaccinated,” a hospital spokesperson told Asheville Watchdog.
That figure for overall staff is slightly higher than the percentage of people in Buncombe County who are fully vaccinated, 52 percent as of Wednesday. The figure for “clinicians” — commonly defined as doctors and nurses and other healthcare professionals who provide direct medical care to patients — suggests that one-third are not fully vaccinated.
At Pardee UNC Healthcare hospital in Hendersonville, an estimated two-thirds of the overall staff has been vaccinated, Pardee’s chief executive said.
At AdventHealth Hendersonville, 65 percent of the staff has been vaccinated, a spokesperson said.
Lindsey Solomon, coordinator for marketing and communications at Haywood Regional Medical Center in Clyde, a Duke LifePoint Healthcare hospital, said that as of Aug. 6 the hospital does not require staff to be vaccinated, but estimated that “more than 70 percent” of the staff had already received a COVID vaccination.
“There is significant evidence that grows daily indicating that the COVID-19 vaccines are safe and effective,” Solomon said.
Raleigh-based WakeMed Health & Hospitals, Durham-based Duke University Health System, Chapel Hill-based UNC Health, Charlotte-based Atrium Health, Greensboro-based Cone Health, Wake Forest Baptist Health and Winston-Salem based Novant Health, all announced last week that they would require everyone on staff to get COVID-19 shots as a condition of continued employment.
Dr. William Hathaway, chief medical officer for Mission Health, HCA Healthcare North Carolina Division, told The Asheville Citizen Times last week that while the new COVID-19 “delta” variant is three to four times more contagious than the “alpha” strain that led to lockdowns last year, the failure to vaccinate all the people who could benefit from inoculations is the main cause of rising cases.
Mission Health this week announced that because of resurgent cases, it has restricted visitation to allow only one visitor per patient per day at Mission and its other hospitals.
But while calling vaccinations “critical” to protecting patients and staff, Mission Health has not joined with the other large hospital systems in making the shots mandatory for staff.
“While colleagues are not required to be vaccinated for COVID-19, our infectious disease experts, as well as those at the CDC, are strongly encouraging vaccination as a critical step to protect individuals from the virus,” said Nancy Lindell, Mission Health spokesperson.
“As a reminder to protect yourself and prevent the spread of illnesses follow the 3 Ws: Wear a mask, Wait 6 feet apart, Wash your hands frequently,” Mission Health advised in a news release this week.
Administrators fear losing staff
“We believe vaccinations are the key to ending this pandemic and strongly encourage all of our team members to get a COVID vaccine,” James M. Kirby II, president and CEO of Pardee, said in a statement last week. However, he said, “After consulting with our clinical and medical staff leadership, Pardee has made the decision to not require or mandate COVID-19 vaccinations for our team members.”
“Several factors played into this decision,” Kirby said, “including an understanding of what we’re experiencing regionally with our workforce, the current [emergency use authorization] status for vaccines, and what’s in the best interest of sustaining services for our community.”
“As the county hospital and a growing regional resource, we are focused on maintaining critical services for our broader community like treating heart attacks or cancer, and addressing day to day urgent and emergent needs,” Kirby continued. “If we were to mandate the vaccine, rather than continuing to encourage and educate, we run the risk of staff departures which would diminish our ability to provide these critical services to our community.”
Kirby said that because Pardee currently does not require a COVID vaccine, it has not required its staff to report whether they’ve been vaccinated or not. “However, based on available reporting metrics and our understanding of vaccinations provided at Pardee to date, we estimate that approximately two-thirds of our team members are vaccinated,” Kirby said.
Almost all hospitals in North Carolina are struggling to attract and retain nurses and nursing assistants, and many of them currently have hundreds of open positions. But many of the largest hospitals calculated that requiring all staff to be vaccinated would be better for patient and staff safety, outweighing the possible loss of staff who decline to get the shots.
The problem is not unique to western North Carolina. “It’s a real problem that you have such high levels of unvaccinated individuals in hospitals,” Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University in Washington, DC, told WebMD Health News.
“We have to protect our health workforce, and we have to protect our patients. Hospitals should be the safest places in the country, and the only way to make them safe is to have a fully vaccinated workforce,” Gostin said.
“Proven to save lives”
Opponents of mandatory vaccination point out, correctly, that the COVID-19 vaccines were rushed through development and have not yet been formally approved by the federal Food and Drug Administration (FDA), although they have been granted emergency use authorization (EUA) status because of the global health crisis.
In an open letter to all residents of Henderson County last week, doctors, nurses, and health officials of Pardee UNC Health, AdventHealth Hendersonville, Blue Ridge Health, and the Henderson County Department of Health all rebutted arguments by anti-vaccine proponents, including one that the “emergency use” status of the COVID-19 vaccines means they are still considered experimental and unsafe.
“The scientific data confirms to us that the COVID-19 vaccine has been proven to save lives,” the clinicians wrote, citing “ample data from millions of vaccine recipients in multiple countries and in multiple settings which verify the original data on which the [emergency use authorization] was based.”
Politics versus science
Vaccination rates are lower than national averages in conservative Western North Carolina. Numerous studies have found a correlation between vaccination rates and political party affiliation. In a recent Washington Post-ABC News poll, 47 percent of Republicans said they were not likely to get vaccinated, compared with 6 percent of Democrats.
Western North Carolina’s freshman Republican congressman, Madison Cawthorn, said in January that he would reject the COVID-19 vaccines, and more recently has been a vocal critic of any efforts to make vaccinations or masking mandatory.
Earlier this month, at a Republican Party conference in Texas, Cawthorn called Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and the nation’s foremost vaccine advocate, a “pawn of the Chinese government” who should be criminally prosecuted if Republicans retake the U.S. House in the 2022 elections.
“Now they’re talking about going door-to-door to take vaccines to the people,” Cawthorn said at the conference in Dallas, referring to the Biden administration’s suggestion of sending volunteers into communities to offer vaccines to the unvaccinated.
Cawthorn said a door-to-door plan would require a “massive” operation.
“Then think about what those mechanisms could be used for,” Cawthorn said. “They could then go door-to-door to take your guns. They could then go door-to-door to take your Bibles.”
The United States Post Office began home delivery operations 219 years ago. Asheville Watchdog has been unable to find evidence that the massive government door-to-door mechanism has been used to seize guns or Bibles.
[This article was updated to include a late response from Haywood Regional Medical Center in Clyde.]
Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Peter H. Lewis is a former senior writer and editor at The New York Times. He can be reached at firstname.lastname@example.org