En español | Only slightly more than a third of nursing home workers who have been offered a first round of COVID-19 vaccine have chosen to get it, according to a new Centers for Disease Control and Prevention (CDC) report. The findings come just after the federal partnership with CVS and Walgreens to prioritize nursing home residents and staff for vaccinations wrapped up its first round of on-site vaccinations.
Participation among nursing home residents — who have accounted for roughly a quarter of COVID deaths since the pandemic began — was much higher, with a median of 78 percent getting the first of two required jabs. But surveying roughly 90 percent of facilities participating in the federal program that had at least one on-site vaccination clinic between Dec. 18 and Jan. 17, the CDC found that only a median of 37.5 percent of nursing home workers received a first dose of a COVID-19 vaccine.
The numbers are worrying because about 70 to 85 percent of a community needs to get vaccinated to achieve herd immunity, according to some medical experts. The CDC report said the low percentage of staff members vaccinated “raises concern about low coverage among a population at high risk for occupation exposure to SARS-CoV-2.”
"Barriers to [skilled nursing facility] staff member vaccination need to be overcome with continued development and implementation of focused communication and outreach strategies,” said the report, released Monday.
Last week, CVS and Walgreens announced the completion of their first round of on-site COVID-19 vaccination clinics in U.S. nursing homes through the federal government's Pharmacy Partnership for Long-Term Care Program. CVS reported visiting all of the almost 8,000 facilities that chose the pharmacy to administer its vaccines, while Walgreens said it visited more than 5,500 facilities.
COVID-19 infections in nursing homes have been spiraling upward in recent months, according to monthly analyses of federal nursing home data by AARP. Staff cases more than tripled between mid-October and mid-December, as resident cases skyrocketed almost fourfold over the same period. Studies show that infected staff members are one of the greatest drivers of COVID-19 outbreaks in nursing homes.
Because the federal government has contracted with CVS, Walgreens and a few state-level pharmacy chains to perform just three on-site vaccination clinics at each of its partnering facilities, pressure is mounting for the second round of clinics, which have already begun, to produce higher uptake rates.
Elaine Ryan, AARP's vice president for state advocacy and strategy integration, says low participation stems from subpar working conditions that nursing home staff have endured for years. “These workers are poorly paid, get few benefits or sick leave and receive very little information and support when they need it,” she says. “Can you blame them for not rushing to get a shot they know very little about, from [the nursing homes] who have treated them so badly?"
The roots of staff skepticism
The national findings match anecdotal evidence that's been echoing through the states for weeks. Maryland's acting secretary of health, Dennis R. Schrader, pegged his nursing home staff refusal rate at somewhere between 50 and 65 percent. In Virginia, Christian Bergman, a member of the state's COVID-19 long-term care task force, estimated that as many as 90 percent of workers had turned down the vaccine at some homes.
Many long-term care workers are skipping COVID-19 vaccines because they're concerned that the shots are ineffective or unsafe, the CDC says. Worries about potential side effects, which have so far been minimal from first doses, are also driving resistance. The report cites a recent survey of long-term care workers that found that among the 55 percent of workers in Indiana who said they would decline a COVID-19 vaccine if offered, 70 percent mentioned side effects as the primary reason.
Many long-term care workers are hourly employees with little to no sick leave or benefits and may not be able to afford to get sick from side effects. Certified nursing assistants, who make up the overwhelming majority of care workers at nursing homes, make less than $15 per hour on average, and getting to work is often their top priority.
Added pressure on second rounds
Now, the pressure is on the second round of nursing home vaccination clinics to reach those who've been missed. Both COVID-19 vaccines authorized in the U.S., from Pfizer and Moderna, require two doses administered up to six weeks apart. Missing a first dose during the second clinic will make it all but impossible for workers to get fully vaccinated through the on-site program. As Ohio Gov. Mike DeWine said in a December address to his state's nursing home workers — of whom 60 percent were reportedly declining first doses — “The train may not be coming back.”
Rina Shah, group vice president of pharmacy operations and services at Walgreens, said in a press briefing that the pharmacy is developing tools to get long-term care workers vaccinated once the program ends. One possibility, she said, is supplying vaccine vouchers to workers who can then take them to a Walgreens clinic to receive a shot. But doing so may put those workers in large queues with millions of members of the general population who are struggling to secure vaccinations.
Mike Wasserman, past president of the California Association of Long Term Care Medicine — which represents doctors, nurses, pharmacists and others in the industry — says the current program needs to be more accommodating. “Instead of a one-size-fits-all, rigid approach,” he says, what's needed is a “more flexible plan that might allow the facility to do its own vaccinations over the course of a week.”
That could also prevent staffing shortages that may arise from inoculating too many workers with second doses at one time. In the Pfizer and Moderna vaccine trials, participants reported feeling worse side effects — mainly fatigue, headache, muscle aches, chills, joint pain and possibly some fever — after their second dose, which could lead to lots of staff calling in sick at once, straining a facility's ability to look after residents at a time of national staffing shortages.
Signs of improvement
Anecdotal evidence from second-round clinics now taking place suggests that vaccine uptake among staff is improving. The Associated Press reported that last week, in a meeting on vaccine policy, Amanda Cohn, the CDC's deputy director of immunization services, said more staffers get vaccinated when a second or third clinic is held at a home. And a CVS spokesperson told USA Today that they are seeing a higher uptake by staff members on their second visits.
Sondra Norder sees the improvements at St. Paul Elder Services in Wisconsin, where she is president and CEO. During the first on-site clinic at her skilled nursing facilities, only 66 percent of staff received a vaccine. On Monday, during the second clinic, that number jumped to 75 percent.
Disclosure: Mike Wasserman sits on the board of AARP charitable affiliate Wish of a Lifetime.