The decision to mandate the COVID-19 vaccine for staff of Wexford-based IntegraCare's long-term care facilities was a matter of life or death for CEO Larry Rouvelas.
“We’ve seen too many people hurt and killed by COVID … the vaccine is the only thing that’s going to make the difference,” said Rouvelas. “If you’re not willing to do what you need to do to protect [residents], you should be working somewhere else.”
Of Pennsylvania's 24,000 COVID deaths, more than half have been among residents of long-term care facilities.
IntegraCare, which owns The Pines of Mount Lebanon, is one of several long-term care companies with facilities in Allegheny County that are now requiring the vaccine for staff.
Rouvelas said IntegraCare consulted an attorney before issuing its policy, but it’s not entirely clear if such a requirement is legal based on December guidance from the U.S. Equal Employment Opportunity Commission.
“[It] suggests that it's not prohibited to ... mandate COVID vaccine even under an Emergency Use Authorization," or EUA, "but didn't explicitly say that it was legal either,” said Mary Crossley, who is director of the Health Law Program at the University of Pittsburgh.
An EUA is issued by the US Food and Drug Administration during medical emergencies. For full FDA approval pharmaceutical companies must submit additional data. Reuters reports that Pfizer will apply to the FDA for full authorization for its vaccine in April. It is unclear when Moderna or the recently-approved Johnson & Johnson plan to do the same.
Crossley noted that the EEOC guidance said employers need to provide exemptions for those citing religious and medical reasons, just as is the case with the seasonal influenza vaccine. At the Pines, Rouvelas said that some employees have qualified for these exceptions, but that there are also a couple staff who do not qualify and are still unwilling to get vaccinated.
So far, the Pines has held two of three vaccine clinics, and Rouvelas is hoping that the holdouts will change their minds.
“We are doing everything we can to persuade them,” he said. “If by that third clinic if they don’t agree then we will proceed to go separate ways.”
Trial data show that the Johnson & Johnson, Moderna and Pfizer-BioNTech vaccines are safe and effective. Real-world administration of both Moderna and Pfizer, which have been in use since December, show the same, along with reason to believe they can stop a vaccinated person from spreading the virus. But because the vaccines are still under emergency authorization only, Duquesne University epidemiologist Faina Linkov said it is premature to mandate the vaccine.
“This is not to say that this is not going to change is a couple months. But I would say as of today, we’re not there yet,” said Linkov, who chairs the Department of Health Administration and Public Health at Duquesne.
Instead of mandating the vaccine, Linkov said employers should focus on educating staff about the vaccine’s benefits, and perhaps even provide incentives to encourage people to get their jabs. Some U.S. long-term care facilities have gone this route by offering paid time off; one Atlanta-based nursing home even raffled off TV sets.
Pitt Law’s Mary Crossley also questions whether it is a good idea to require staff of long-term care facilities to get the COVID vaccine since much of this workforce comprises people from Black and brown communities, which have historically been mistreated by medical providers.
“Does it make any sense to kind of alienate staff by telling them they have to do something they're not comfortable with? And then if you end up firing staff because they don't, then you just have further [staffing] shortages?” said Crossley. “I just I think it could really backfire in some serious ways with employers.”
That doesn't seem to be an issue at the Pines; IntegraCare's Larry Rouvelas says some 94% of staff have gotten the vaccine so far.
“We choose the harder path, but it’s the right path," he said. "I have 100% confidence that this policy will save the lives of seniors."
