Arleene Meertens saw the worst of the COVID pandemic as a patient care technician at Kingsbrook Hospital in Flatbush. During Brooklyn’s first wave, she watched patient after patient struggle to pull oxygen into their damaged lungs before turning grey and passing away. She could do little more than hold their hands and hope their final moments felt less lonely.
But when it came time to get her COVID-19 vaccine, the drug that leaders promised would finally banish the pain of the pandemic, she held back.
“This is my body, this is my temple, and no one [has] a right to force me to do what I don’t want to do,” she said, adding that maybe in four or five years, she would have considered it.
Her strong reluctance is emblematic of a small but significant trend among health care workers. Even before COVID-19 emerged, disparate vaccination rates had been observed for the annual flu shots—with physicians tending to have the highest coverage, followed by nurses. Nurses assistants and aides got flu vaccines at about a quarter the rate of physicians and nurses, according to data from the Centers for Disease Control and Prevention.
The COVID-19 vaccines thrust this hesitancy into the mainstream. As vaccine mandates in the industry became likely, and now a reality, there have been frequent protests among health care workers. Ahead of New York’s mandate, more than one in five hospital workers hadn’t been inoculated, and the hesitancy rates were even higher among nursing home employees.
The stalwart opposition from some health care workers has raised questions about why people in science-based professions, who saw the most devastating impacts of the pandemic first-hand, could shun the cure. Health experts cite a combination of factors, such as lower-level health care professionals being left out of the decision-making process around workplace requirements.
Other major factors include the proliferation of misinformation about vaccines and the need to update medical curriculum—especially in nursing—to contend with misinformation. This spring, the American Association of Colleges of Nursing began issuing $100,000 grants, funded by the CDC, to reinforce vaccine education resources for students and providers.
“Nurses fall prey to the same misinformation that non-medical professionals do,” said Blima Marcus, an oncology nurse at a chemotherapy clinic and professor of nursing at Hunter College.
The same goes for other health care professionals like Meertens. Meertens said she worried about how fast the vaccines were developed despite the shots incorporating more than a decade of research. She said she’d seen videos circulating on WhatsApp that claimed to show side effects of COVID-19 vaccines. Other videos she was sent were of speakers from the anti-vaccine movement known for spreading misinformation even before the pandemic.
Eight months later, she was still holding out when the state announced in mid-August that health care workers like her would be mandated to take the vaccines. She was furious, despite doses among hundreds of millions of recipients showing the drugs to be safe and effective.
“I hate the fact that they’re forcing us to do what we don’t want to do,” Meertens said.
Vaccines were so taken for granted because we knew they worked. We knew they saved lives.
Marcus has long spearheaded efforts to tackle such hesitancy and outright debunk anti-vaccine propaganda, such as during the 2019 measles outbreak when misinformation flooded Orthodox Jewish communities in New York City and Rockland County. The latest pandemic intensified her work, and she has spent much of her spare time countering misinformation about COVID-19 vaccines being spread among her nursing colleagues on Facebook.
In the hospitals and clinics where she worked and throughout her professional network, Marcus has noticed anecdotal patterns of vaccine hesitancy along professional and political lines. This spring, the health policy group KFF recorded similar trends regarding frontline health care workers: vaccine confidence was higher among Democrats; those with postgraduate degrees; and those who are white or Hispanic. According to a study published around the same time in the Journal of Community Health, the most common concerns among vaccine-hesitant health care workers centered around safety, efficacy, and potential side-effects of the COVID-19 vaccines.
These divides continued throughout the summer, even as the delta variant spawned another wave of cases and hospitalizations. A nationwide survey of health care workers, released in August by The COVID States Project, found vaccination rates were higher among higher-paid and more highly-educated health care workers. It also gleaned a chasm between medical employees who identified as Democrats—this group had a vaccination rate of over 80 percent. Republican health care workers reported a rate of less than 70 percent. Separately, KFF made similar findings for the general public.
Marcus said she is concerned that undergraduate nursing education hasn’t been updated to reflect this undercurrent of vaccine hesitancy. When she was an early nursing student between 2008 and 2010, her lecturers didn’t dive deeply into subjects like vaccine science or epidemiology or teach how to interrogate scientific studies. Those lessons didn’t arrive until her master's and doctorate level classes.
The power differentials that we see within these institutions exacerbate the mistrust issues.
“Vaccines were so taken for granted because we knew they worked. We knew they saved lives. It was as simple as Tylenol. You don’t need a lesson on why Tylenol works,” she said. “People want more information, and in a way, of course, they’re entitled to that, but that also means the education needs to change for those providers.”
Beyond changing curriculum and doing a better job of debunking misinformation, Dr. Jasmine Travers, an assistant professor at New York University’s Rory Meyers College of Nursing, said support staff—such as nursing assistants and patient care technicians— should have greater input when implementing future public health guidance. She gave the example of having “nursing assistant ambassadors” that hospital managers could regularly consult to spot concerns among staff early on and generate ideas on how to handle them.
“The power differentials that we see within these institutions exacerbate the mistrust issues that we’ve seen among these groups,” Travers said. “They should be on the decision-making team.”
As New York and the nation moved into the autumn and faced another potential wave, mandates became the go-to option for improving vaccination rates among health care workers. Early data suggests New York’s requirement for most health care workers is having its intended effect of boosting immunization rates. Last week after the mandate took effect, about 90 percent of hospital and nursing home workers were fully vaccinated, up from around 75 percent a month and a half ago when the rule was announced.
Meertens, who now works at Brookdale Hospital, held out until the last moment. Unable to risk losing her job, she got her first dose of the COVID-19 vaccine on September 27th, the same day the mandate was triggered. But she wasn’t happy about it.
“We were last year’s heroes, and this year, we are nothing,” she said. “They do not respect our decision.”
