In July, the Biden administration announced that every federal government employee and onsite contractor would be asked to attest to their vaccination status and unvaccinated individuals would be required to wear masks at work and comply with weekly or twice weekly COVID-19 testing. He also called on the private sector to do more to encourage their employees to get vaccinated. On September 9, 2021, Biden issued an executive order requiring COVID-19 vaccination for all Federal employees, subject to such exceptions as required by law. Since then there has been building momentum nationally toward mandated COVID-19 vaccination of health care workers (HCW).

The Centers for Medicare & Medicaid Services (CMS) has taken action to require COVID-19 vaccinations for workers in most health care settings that receive Medicare or Medicaid reimbursement such as hospitals, dialysis facilities, ambulatory surgical settings, and home health agencies. Vaccination requirement for nursing home facilities was previously announced and will apply to nursing home staff as well as staff in hospitals and other CMS-regulated settings.  

There is still much polarization among HCWs and others who serve the public about this issue. It does appear that more and more stakeholders have difficulty fathoming how any HCWs — PAs, nurse practitioners, physicians, and nurses —could square not getting vaccinated with their mission to preserve and improve the health of all Americans. I find that difficult to fathom as well.


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The rationales for not getting vaccinated are now familiar to us all. They include questions such as:

  1. How do we know the vaccines are safe? Are they still considered “experimental?” [Editor’s Note: The Food and Drug Administration approved the Pfizer-BioNTech COVID-19 Vaccine on August 23, 2021. The vaccine is marketed as Comirnaty.] Additionally, did the speedy pace of the COVID-19 vaccine development increase risk of poor outcomes from the vaccine?
  2. Isn’t herd immunity via previous infection preferable to herd immunity via vaccine?
  3. Why should we trust our government when viewing the abuse of public trust that has occurred in the past, particularly related to minority communities?
  4. Why should I give up my personal autonomy and freedom to get a vaccine that I don’t want?

Advocates of universal vaccination argue it is needed to help reduce morbidity and mortality related to the COVID-19 epidemic.  However, the gap appears to be hardening between those hesitant or opposed to getting the vaccine and those convinced that getting vaccinated is part of the commitment HCWs should have toward the health of the public and the patients for whom they treat.

I know of many PAs who have privately expressed increased annoyance and exasperation with fellow PAs who continue to decline vaccination, even in the face of a national spike in illness and deaths related to the virus. As of the writing of this piece, the number of deaths from COVID-19 reached over 41,367,000 cases and over 663,963 people have died from the disease.

Recent expansion of mandated vaccines will hopefully make universal vaccination of HCWs a more attainable goal, but even with the recent local, state, and federal mandates for HCWs and state/federal employees, many resisters have hardened their antivaccine stance. One example of this has been the emergence of resistance among state police officers and firefighters in the state of Washington.

These are men and women who have dedicated their lives to protecting and saving people yet to get a vaccine that has unanimous support in the mainstream scientific and medical community and that has the proven ability to help these employees keep the public they serve safer. In Washington, state patrol officers take a vow to “obey the orders of the Governor and the State of Washington.” Well, the governor has spoken and ordered them to get the vaccine.     

To date, there have been no successful legal actions challenging mandatory vaccines, including the well-known adoption of mandatory vaccines at Houston Baptist Medical Center. Additionally, legal challenges to the adoption of vaccine requirements by more than 500 universities and colleges have failed, while some are still in the legal process. Of note, judges in 2 prominent cases were appointed by Republican presidents and both have upheld the rights of medical facilities, state governments, and colleges/universities to mandate that students and employees receive COVID-19 vaccines.   

These legal battles will likely continue, as will the ideological clashes between hesitant/resistant HCWs and those in support of mandatory vaccines. What I am most puzzled by is how PAs or NPs could dedicate their lives to improving the health of the public, yet risk the health of patients by treating them without having received a COVID-19 vaccination. The data could not be clearer regarding the significant health benefits to both provider and patient by getting vaccinated, as well as the remarkable and documented safety of the vaccines.

PAs and NPs became HCWs because of their commitment to the health and safety of our patients. It is difficult to see the refusal to get vaccinated as anything other than an extreme abrogation of such a foundational commitment.