Driven by “vaccine hesitancy” among workers, more than half the staff and residents in Michigan’s skilled nursing homes have declined to be vaccinated against COVID-19 so far, according to data collected by the Michigan Department of Health and Human Services.
Last week, Walgreens and CVS finished their first round of vaccination clinics held at 414 Michigan nursing homes. About 38,500 were immunized — 43% of the 90,000 individuals eligible for vaccinations.
Such a low immunization rate likely delays the ability of nursing homes to lift coronavirus-related restrictions that have been in place since last March. It also means many nursing homes remain vulnerable to coronavirus outbreaks that have ravaged facilities and killed thousands of their residents to date.
“These numbers we’re seeing are not surprising. But they are troubling, and we need to do with what it takes to address it,” said Dr. Abdul El-Sayed, former head of the Detroit Health Department who is working with the Service Employees International Union in Michigan on the issue of vaccine hesitancy.
“Given the fact that (long-term care facilities) have been the epicenter of the pandemic, it is critical that people get vaccinated,” he said.
Neither MDHHS nor the Health Care Association of Michigan, the organization that represents nursing-home operators, have a breakdown of vaccination rates of employees compared to residents. But anecdotal reports indicate nursing-home residents have been much more open to vaccination than workers, said Melissa Samuel, who heads the HCAM.
“I don’t have specific numbers, but residents are taking it at a much higher rate,” Samuel said.
That makes sense, she said: Residents of skilled-nursing facilities are at especially high risk of dying from COVID-19 because of their age and health status.
“They want the vaccine, and the same is true of residents in other long-term care facilities,” such assisted-living sites, Samuel said.
To date, 3,961 Michigan residents and 38 workers at skilled nursing homes have died of COVID-19 to date. That doesn’t include another 1,413 deaths linked to other long-term care facilities, such as assisted-living sites for senior citizens. In all, deaths linked to long-term care facilities account for 37% of the state’s COVID-19 deaths.
By comparison, nursing-home workers tend to be younger and have much milder cases of COVID-19. Many also are skeptical of the vaccine, El-Sayed said.
“You have to appreciate the circumstances in which many of these workers have been living for the past year,” said El-Sayed, who recently spoke at an SEIU forum to talk with union members about the science around the vaccine and answer questions. “A lot of these folks have been surrounded by COVID for the last year — they’ve worked in the epicenter of the pandemic; 40% of all pandemic deaths have been residents of long-term care facilities.
“So if they’ve had it already, they’ll say, ‘Why should I get vaccinated now?’ Which, of course they should, but you can understand the logic there,” he said. “The second thing they say is, ‘If I haven’t gotten it yet, I’m probably not going to get it,’ which is also failed logic, but you can appreciate where that feeling might come from.”
Their skepticism of the vaccine indicates “we have not done a good job of engaging with folks generally about how this vaccine works, why we were able to create it so fast and why it’s important to take it,” El-Sayed said.
“Then you add in the Trump show and the absurd of politicization of science throughout this pandemic, and then add in the history of of exploitation of Black Americans” in regards medicine and science, “and you come to appreciate why there’s so much hesitancy,” he said. “And the other part of it is that there’s like just a profound space for disinformation all over the Internet.”
Yet another factor for the low vaccination rates is the fact that nursing home staff were among the first groups to be eligible for the vaccine, said Samuel and El-Sayed. While that prioritization made lots of sense considering the disproportion number of COVID-19 deaths linked to nursing homes, it also meant many nursing-home workers were unwilling to be on the front end of what they felt like was a mass experiment.
“It was the right decision to make long-term care facilities a priority and put us in the 1A category” for vaccinations, Samuel said. “That absolutely had to happen. But in doing so, we didn’t have all the advocacy in place and at the federal level, there were several weeks that there was really no information about COVID, let alone the vaccine, the need to take the vaccine and vaccine safety.”
Frontline hospital workers also were in the first group to be vaccinated. About 60% to 65% of eligible employees in that group — which included doctors and nurses as well as support staff such as aides, security and housecleaning — agreed to be immunized, according to a survey by the Michigan Health and Hospital Association.
That reflects the difference between nursing-home workers and a hospital staff in which many employees have strong backgrounds in science, El-Sayed said. “If you’re a physician, your understanding of how the vaccine was created and why it’s necessary may be different than if you’re working in a long-term care facility and maybe haven’t had the same training.”
Nursing-home operators and union leaders are now working to provide workers with opportunities to get their questions answered about the vaccine, Samuel and El-Sayed said, and there’s hope that staffers will get more comfortable with the vaccination program as they see nursing-home residents and co-workers participate.
“We had an election in November and you saw all the efforts undertaken across the board to get out the vote,” Samuel said. “That’s truly the kind of effort we should be putting out as far as taking the vaccine.
“People want more information,” she said. “They want to be confident that the vaccine is safe, and at this point it’s all about education.”
Compared to the bulk of coronavirus vaccinations in Michigan, the program for staff and residents of long-term care facilities is being administered through a contract between the federal Centers for Disease Control and CVS and Walgreens.
The two pharmacies have each been assigned long-term care facilities, and are holding on-site vaccination clinics there. Phase I of the program, which targeted skilled nursing homes, began Dec. 28. Phase II, which includes all other long-term care facilities such as assisted living centers and adult foster homes, began Jan. 4.
MDHHS has made the LTC program a top priority, allotting it 29% of the vaccine doses distributed to Michigan so far.
Lynn Sutfin, spokeswoman for MDHHS, noted that CVS and Walgreens will hold a total of three vaccination clinics at each facility, each spaced a month apart, to administer second doses and give staff and residents multiple opportunities for a first dose.
Samuel said it’s her fervent hope that employees will take advantage of that.
The 43% vaccination was for the first round of clinics, “but there’s absolutely the opportunity at the second clinic and even the third clinic” to participate in the vaccination program, Samuel said. “As people learn more and feel more confident, I think that will happen. I think it’s happening now.”
El-Sayed agreed to that vaccination rates are likely to go up.
“I do think we’re going start seeing more people taking the vaccine in subsequent rounds,” he said. “I certainly appreciate the hesitation and fear that folks had. But I also think as the vaccine has been around longer and more people are taking it and feeling fine, some of that hesitation will go away.
“Also, it’s likely given where we are with this pandemic,” he said. “We’ve got these variants that are coming around, whether it’s the UK. or the South African or the Brazilian variants. That pushes information out there about vaccine, the imminent need to do it fast, particularly among people who are at highest risk of being infected – and especially people who are living in long-term care or working in care facilities. That‘s going to change some of the calculations that folks make, and so I think that you’re going to start to see more uptake on the second and third rounds.”
And he hopes that’s the case, considering the importance of having high vaccination rates in long-term care facilities.
“The higher the number of people getting vaccinated inside long term care facilities, the lower the risk of an outbreak,” El-Sayed said. “The point that I make to workers is, that it’s like the pandemic is World War II and you all are the frontline in the trenches. You need something to protect you, and the vaccine is like putting on your armor. And it’s absolutely critical that if anybody is to put on armor, you need to put it on first.”
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