Velandy Manohar, MD.,
Distinguished Life Fellow, Am Psychiatric Assoc.
07 26 21
Context for establishing policies for requiring COVID -19 Vaccinations among staff providing Health Care.
Fauci: 'We're going in the wrong direction' on Covid-19 cases - CNNPolitics (click to watch video)
By Chandelis Duster, CNN
Updated 5:28 PM ET, Sun July 25, 2021
Dr. Anthony Fauci said Sunday that the US is "going in the wrong direction" as the number of Covid-19 cases continues to rise, particularly among unvaccinated Americans.
"If you look at the inflection of the curve of new cases and, as you said in the run-in to this interview, that it is among the unvaccinated. And since we have 50% of the country is not fully vaccinated, that's a problem," Fauci told CNN's Jake Tapper on "State of the Union" when asked about a model projecting a worst case scenario of 4,000 deaths a day in the US from Covid-19, if vaccination rates do not improve.
The chief medical adviser to President Joe Biden and the nation's top infectious disease expert added that the majority of those deaths could be among the unvaccinated.
"So it really is, as (US Centers for Disease Control and Prevention) Dr. (Rochelle) Walensky has said many times and I have said, it is really a pandemic among the unvaccinated, so this is an issue predominantly among the unvaccinated, which is the reason why we're out there, practically pleading with the unvaccinated people to go out and get vaccinated," he said.
The warning from Fauci comes as the dangerous Delta variant of Covid-19 sweeps across the nation and health officials caution Americans to remain vigilant in preventing its spread. Every state in the US reported more Covid-19 cases in the week ending Friday than the week prior, according to data from Johns Hopkins University, with the gravity of the situation evident from coast to coast.
Thirty states have yet to fully vaccinate at least half of their residents, according to the CDC. And as of Friday, the daily average of people becoming fully vaccinated was the lowest it had been since the end of January.
CNN previously reported that discussions within the Biden administration on whether to revisit mask guidelines are ongoing and that the CDC is reconsidering its stance on mask orders, according to sources familiar with the talks. Fauci on Sunday said revising mask guidance for vaccinated Americans is under "active consideration" and that he is part of the discussion.
Fauci said local decisions saying vaccinated people should wear a mask, such as those occurring in virus hotspots like Los Angeles County in California, are not incompatible with the CDC's overall recommendation that gives a lot of discretion to local governments.
"We're seeing that in LA. We're seeing that in Chicago. We're seeing that in New Orleans," Fauci said. "The officials there, many of them are saying even if you are vaccinated, it's prudent to wear a mask indoors."
CNN's Travis Caldwell and Kevin Liptak contributed to this report.
AHA Calls for Vaccine Mandate in Health Care Facilities (webmd.com) [Please scroll down for report]
WASHINGTON, D.C. (July 21, 2021) – The American Hospital Association (AHA) Board of Trustees today adopted a policy statement on the vaccination of health care workers. The statement supports hospitals and health systems that adopt mandatory COVID-19 vaccination policies, with local factors and circumstances shaping whether and how these policies are implemented. In addition, the AHA continues to strongly urge the vaccination of all health care personnel to protect all patients and communities from the risks of COVID-19.
“The evidence is clear: COVID-19 vaccines are safe and effective in reducing both the risk of becoming infected and spreading the virus to others,” said Rick Pollack, AHA’s president and CEO. “The AHA supports hospitals and health systems that choose, based on local factors, to mandate COVID-19 vaccines for their workforce. Doing so will help protect the health and well-being of health care personnel and the patients and communities they proudly serve.”
The full policy statement from the AHA on the vaccination of health care workers can be found HERE.
American Hospital Association Policy Statement on Mandatory COVID-19 Vaccination of Health Care Personnel
Approved by the Board of Trustees - July 21, 2021
America’s hospitals and health systems are committed to protecting the health and well-being of health care personnel and the patients and communities that they serve. The best available scientific evidence indicates that:
• COVID-19 vaccinations are safe.
• COVID-19 vaccinations are effective at reducing both the risk of becoming infected and spreading the infection to others.
• COVID-19 has a significant risk of transmission both before the onset of symptoms and in the absence of symptoms. These risks are substantially higher among unvaccinated individuals.
• Among unvaccinated individuals, COVID-19 infections pose a substantial risk of severe illness and death and may lead to long-term adverse impacts to health. These risks are higher among those individuals with certain underlying health conditions, like many patients in hospitals or who are seen in hospital-based ambulatory settings.
[Thus] To protect all patients, communities and personnel from the known and substantial risks of COVID-19, the American Hospital Association (AHA) strongly urges the vaccination of all health care personnel. COVID-19 vaccines protect health care personnel when working both in health care facilities and in the community.
They provide strong protection against workers unintentionally carrying the disease to work and spreading it to patients and peers.
The AHA also supports hospitals and health systems that adopt mandatory COVID-19 vaccination policies for health care personnel, with local factors and circumstances shaping whether and how these policies are implemented.
The AHA encourages hospitals and health systems implementing mandatory COVID-19 vaccination policies to:
• Provide exemptions for medical reasons and accommodations consistent with Federal Equal Employment Opportunity Commission guidelines (e.g., a sincerely held religious belief, practice or observance);
• Follow relevant Centers for Disease Control & Prevention (CDC) infection control guidelines, Occupational Safety and Health Administration requirements, and other federal and state regulations regarding use of personal protective equipment and other infection control practices for unvaccinated staff receiving an exemption or accommodation. For example, unvaccinated personnel may be required to wear a mask at all times even if CDC guidelines and OSHA requirements were to relax mask requirements for vaccinated personnel; • Ensure the policy is implemented in a manner consistent with local and state laws;
• Follow requirements and guidelines from the Food and Drug Administration (FDA) and CDC on which individuals are eligible and should be prioritized for vaccination;
Monitor national safety and efficacy data for all FDA authorized or approved vaccines in use;
• Continue providing education about the efficacy and safety of COVID-19 vaccines to encourage staff to obtain the vaccine voluntarily; and
• Offer scheduling flexibility and/or time off to ensure personnel have time to obtain the vaccine and recover from its possible side effects.
Doctors, nurses, medical groups call for mandatory vaccinations of health-care workers
BY PETER SULLIVAN - 07/26/21 09:10 AM EDT
Leading groups for doctors, nurses and other health care professionals are calling for COVID-19 vaccines to be mandated for health care workers as vaccinations lag amid the spread of the delta variant.
"Due to the recent COVID-19 surge and the availability of safe and effective vaccines, our health care organizations and societies advocate that all health care and long-term care employers require their workers to receive the COVID-19 vaccine," the American Medical Association, American Nurses Association and more than 50 other health care groups said in a statement on Monday. "This is the logical fulfillment of the ethical commitment of all health care workers to put patients as well as residents of long-term care facilities first and take all steps necessary to ensure their health and well-being."
Despite working with vulnerable people, many staff at long-term care facilities are not vaccinated. ProPublica reported last week that only 59 percent of workers at nursing homes and other long-term care facilities had at least one shot, citing government data.
The new call comes as the delta variant fuels an increase in cases in the U.S., primarily among the unvaccinated.
As the vaccination rate lags, many experts say mandates from employers could play a bigger role in boosting the number of people getting the shots, as the role of incentives and persuasion could be fading in usefulness.
"Unfortunately, many health care and long-term care personnel remain unvaccinated," the groups said in Monday's statement, which was first reported by The Washington Post. "As we move towards full FDA [Food and Drug Administration] approval of the currently available vaccines, all health care workers should get vaccinated for their own health, and to protect their colleagues, families, residents of long-term care facilities and patients."
Full FDA approval is also seen as a key step in encouraging more people to get the vaccine.
The health care groups also said they hope all employers will require vaccines for their workers.
"As the health care community leads the way in requiring vaccines for our employees, we hope all other employers across the country will follow our lead and implement effective policies to encourage vaccination," they said. "The health and safety of U.S. workers, families, communities, and the nation depends on it."
ANA Position Statement
Approved: July 22, 2020, updated June 29, 2021
This position statement supersedes the Position Statement on Mercury in Vaccines, June 21, 2006.
Historically, the American Nurses Association (ANA) has strongly supported immunizations to protect the public from highly communicable and deadly diseases such as measles, mumps, diphtheria, pertussis, and influenza (ANA, 2019; ANA, 2015; ANA, 2006), and has supported mandatory vaccination policies for registered nurses and health care workers under certain circumstances. Considering several recent and significant measles outbreaks in the United States, as well as the global pandemic of COVID-19, ANA has reviewed our current position statement for clarity and intent and examined present best practices and recommendations from the broader health care community.
STATEMENT OF ANA POSITION
Effective protection of the public health mandates that all individuals receive immunizations against vaccine-preventable diseases according to the best and most current evidence outlined by the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP). All health care personnel (HCP), including registered nurses (RNs), should be vaccinated according to current recommendations for immunization of HCP by the CDC and Association for Professionals in Infection Control and Epidemiology (APIC). ANA also believes that it is imperative for everyone to receive immunizations for vaccine-preventable diseases as vaccines are critical to infectious disease prevention and control. Moreover, nurses have a professional and ethical obligation to model the same health care standards they prescribe to their patients.
ANA does not support any exemptions from immunization other than for medical contraindications. All requests for medical exemption from vaccination should be accompanied by documentation from the appropriate authority to support the request. Recertification of the medical exemption is an annual obligation. Individuals exempted from vaccination may be required to adopt measures or practices in the workplace to reduce the chance of disease transmission. Employers should offer reasonable accommodations in such circumstances. ANA does not endorse philosophical or religious exemptions.
ANA strongly recommends that all registered nurses, health care workers and the public be vaccinated against COVID-19. There is significant clinical evidence on the safety and effectiveness of the three approved COVID-19 vaccines (Pfizer-BioNTech, Moderna, and Johnson & Johnson/Janssen) being administered under the Food and Drug Administration’s (FDA) Emergency Use Authorization process. With regard to these three vaccines, ANA does not support any exemptions other than for medical contraindications to being vaccinated against COVID-19.
As novel diseases emerge, such as COVID-19, ANA supports ongoing research and development of safe, easily accessed vaccinations for these public health threats. Vaccinations must be available and accessible to all to ensure public health and safety.
Andrea Mitchell Reports- MSNBC reported that fifty plus Health Care and Medical groups were supporting policies seeking high rate of Vaccinations among staff including Mandating Immunization.
AMA endorses guidelines for vaccine mandates and credentials
JUN 16, 2021
CHICAGO — Wading into the contentious issues of vaccine mandates and vaccine credentials, the American Medical Association (AMA)adopted policy that calls for strong protections for privacy and equity when considering these proposals.
At the Special Meeting of its House of Delegates, the AMA said a well-designed education and outreach effort is necessary to promote vaccinations and to protect public health and public trust.
Before mandating COVID vaccinations, the AMA recommended that:
- The vaccine receive full approval from the Food and Drug Administration through a Biological Licenses Application.
- The mandate follow the recommendations of the Advisory Committee on Immunization Practices as approved the by CDC director.
- Individuals subject to the mandate be given meaningful opportunity to voluntarily accept vaccination.
- Implementation of the mandate not exacerbate inequities or adversely affect already marginalized populations
All states employ vaccine mandates in some form, most notably vaccine requirements for students. Many states require staff of health care institutions to be vaccinated for a range of infectious diseases. While mandating COVID vaccination is a pathway toward achieving herd immunity, a mandate also may further alienate individuals who are mistrustful of authority, the AMA policy noted.
“Given the high rate of asymptomatic transmission in COVID-19, vaccinating the greatest number of individuals possible is critical. While vaccines are highly effective public health tools, vaccine mandates are a blunt instrument and may carry the risk of eroding trust and undermining public health goals,” said AMA President Gerald E. Harmon, M.D. “We can reach herd immunity with a robust public campaign which would have the benefit of respecting patients’ autonomy and minimize disproportional burdens on marginalized communities. Failure to achieve herd immunity is more likely to result in mandates.”
As for digital vaccine credentials (often referred to by the misnomer “vaccine passports”), the AMA called for the federal government to play a role in establishing, publicizing and enforcing guidelines for use of digital credentials.
The AMA policy said that prior to implementing use of digital vaccine credentials, the following must occur:
- Vaccine is widely accessible.
- Equity-centered privacy protections are in place to safeguard data collected from individuals.
- Provisions are in place to ensure that digital vaccine credential do not exacerbate inequities.
- Digital credentials have a way to address the situation of individuals for whom vaccine is medically contraindicated.
“The Biden administration has said it is not creating federal digital vaccine credentials. Nonetheless, the federal government must be vigilant on issues of equity and privacy. We can’t leave these decisions to the app marketplace which profits by exploiting user data,” Harmon said.
ph: (202) 789-7442
IV. Web MD Report 07 23 21
AHA Calls for Vaccine Mandate in Health Care Facilities
By Ken Terry
July 23, 2021 -- A widespread movement to require all health care workers to get vaccinated received a big boost from the American Hospital Association this week.
The Association, which represents nearly 5,000 hospitals, issued a policy statement Wednesday that strongly urges COVID-19 vaccination of all health care personnel.
"The AHA also supports hospitals and health systems that adopt mandatory COVID-19 vaccination policies for health care personnel, with local factors and circumstances shaping whether and how these policies are implemented," the statement said.
The AHA said it was taking this position because vaccination protects not only health workers, but also patients from contracting the deadly disease.
Since Houston Methodist Hospital became the nation's first institution to establish a vaccine mandate last winter, dozens of hospitals and health systems have followed suit, including some of the largest U.S. health care organizations.
Among the health systems currently requiring vaccination, according to Becker's Hospital Review, are Banner Health, University of Chicago Medicine, Trinity Health, Mass General Brigham, Beth Israel Lahey Health, Hackensack Meridian Health, University of Mississippi Medical Center, Piedmont Healthcare, Virtua Health, Inova Health System, Mercy Health, Yale New Haven Health, Henry Ford Health System, SSM Health, NewYork-Presbyterian, RWJBarnabas Health, and University of Pennsylvania Health System.
In addition, New York City has imposed a vaccine mandate on employees of its public hospitals and clinics, and San Francisco requires personnel in high-risk settings such as skilled nursing facilities, acute care hospitals, homeless shelters, and jails to be vaccinated, according to Becker's.
The facilities that belong to the Connecticut and Maryland hospital associations have agreed to establish vaccination mandates, as well.
There was some initial hesitancy among providers about requiring vaccines that had received only emergency use authorizations from the FDA. However, a federal judge in June upheld Houston Methodist's mandate. And in a town hall broadcast on CNN on Wednesday, President Joe Biden predicted that the vaccines will receive full FDA approval by the fall.
Besides the AHA, a number of other health care associations have endorsed vaccine mandates for workers. These include America's Essential Hospitals, the Association of American Medical Colleges, and a group of seven professional associations.
Many Workers Still Unvaccinated
The rapidly growing movement to require vaccinations in healthc are parallels the fast rise of the Delta variant of COVID-19 in the U.S. and abroad. With the daily tally of new cases approaching 40,000 in this country, 1-in-4 American health care workers were unvaccinated as of May.
The AHA couched its support for vaccine mandates with several caveats. Among other things, the association encouraged hospitals that require vaccination to:
- Provide exemptions for medical reasons and accommodations consistent with federal Equal Employment Opportunity Commission guidelines.
- Follow the infection control guidelines of the CDC, Occupational Safety and Health Administration requirements, and other federal and state regulations on personal protective equipment and other infection-control practices for unvaccinated staff who receive an exemption or an accommodation.
- Continue providing education about the effectiveness and safety of COVID-19 vaccines to encourage staff to obtain the vaccine voluntarily.
- Offer scheduling flexibility and/or time off to ensure personnel have time to obtain the vaccine and recover from its possible side effects.
In an interview with in April, Houston Methodist CEO Marc Boom, MD, noted that his health system had been aggressively vaccinating its workers since January, and that it offered them $500 bonuses to get shots by mid-March.
At that point, 84% of the employees had been vaccinated, he said. Nearly all of the system's personnel had gotten shots by the time 178 unvaccinated workers were suspended without pay on June 7.
Asked why this step was necessary, Boom replied, "Our sacred duty and obligation is to care for our patients and to care for them in the safest possible manner. Part of that is to make sure that our team is protected and that we minimize the chance of giving COVID to a patient. It's about patients being at the center of everything we do." [The most Valued Tenet of Medical Ethics dating back 2000 years to Hippocrates is ”Foremost, Do No Harm-‘Primum Non Nocere’- VM]
Medscape Medical News
© 2021 WebMD, LLC. All rights reserved.
CT hospitals back vaccine mandate for employees
Connecticut hospitals on Thursday said they are backing a policy that will require their workers to get vaccinated against COVID-19.
The Connecticut Hospital Association (CHA), the lobbying arm of the state’s hospitals, said it has adopted a consensus, statewide policy endorsing mandatory COVID-19 vaccination for hospital and health system employees and clinical staff.
A CHA spokesperson said Connecticut hospitals are committed to implementing the policy.
“Hospitals are leaders in Connecticut’s response to the pandemic and we believe taking this step is in further support of public health and the safety of our patients and workforce,” said Jennifer Jackson, CEO of the association. “The science is clear, vaccines are safe and effective, and are proving to be the best way to eliminate the spread of COVID-19 in our state.”
The policy is similar to one Connecticut hospitals adopted 10 years ago when they required employees to receive the flu vaccine, CHA said.
Vaccine mandates have become a hot-button issue for employers, but legal experts have been increasingly suggesting that employers have the right to mandate vaccinations.
However, many businesses have opted to recommend vaccinations rather than mandate them.
Foundational Ethical Principles: These inform my thoughts and decisions as reflected in my recommendations. Velandy Manohar, MD., DLFAPA
Principle of Double Effects (PDE) Double Effect Reasoning, Doctrine of Double Effects. [Document Attached]
The Doctrine of Double Effects consists of four conditions that must be satisfied before an act is morally permissible:
- The nature-of-the-act condition. The action must be either morally good or indifferent.
- The means-end condition. The bad effect must not be the means by which one achieves the good effect.
- The right-intention condition. The intention must be the achieving of only the good effect, with the bad effect being only an unintended side effect.
- The proportionality condition. The good effect must be at least equivalent in importance to the bad effect.
B. The Nuremberg Code, Belmont Principles and Principles of Medical Ethics.[ Page 4 plus]
A common framework used in the analysis of medical ethics is the "four principles" approach postulated by Tom Beauchamp and James Childress in their textbook “Principles of biomedical ethics.”
It recognizes four basic moral principles, which are to be judged and weighed against each other, with attention given to the scope of their application.
The four principles are:
Respect for autonomy - the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)
Beneficence a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
Non-maleficence - "first, do no harm" (Primum Non Nocere).
Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (Fairness and Equality).
Other values that are sometimes discussed include:
Respect for persons - the patient (and the person treating the patient) have the right to be treated with dignity.
Truthfulness and honesty - the concept of informed consent has increased in importance since the historical events of the Doctors' Trial of the Nuremberg trials and Tuskegee syphilis experiment. Values such as these do not give answers as to how to handle a situation but provide a useful framework for understanding conflicts.
When moral values are in conflict, the result may be an ethical dilemma or crisis. Sometimes, no good solution to a dilemma in medical ethics exists, and, on occasion, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the individual patient, family, or larger non-medical community.
Conflicts can also arise between health care providers, or among family members. Some argue for example, that the principles of autonomy and beneficence clash when patients refuse blood transfusions, considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era.
AMA CODE OF MEDICAL ETHICS AMA PRINCIPLES OF MEDICAL ETHICS
∗ Preamble The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self.
The following Principles adopted by the American Medical Association are not laws, but standards of conduct that define the essentials of honorable behavior for the physician.
Principles of medical ethics
- A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
- A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
- A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
- A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.
- A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
- A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
- A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
- A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
- A physician shall support access to medical care for all people
Copyright © 2016 American Medical Association. Distribution, printing, or copying of this PDF is strictly prohibited without the written permission. Distribution, printing, or copying of this PDF is strictly prohibited without the written permission of the American Medical Association.
By Dan Diamond
July 13, 2021 at 11:30 a.m. EDT
A coalition of health-care organizations called on medical facilities Tuesday to mandate that their workers get vaccinated against the coronavirus, saying the strategy has worked to fight influenza and other infectious diseases and is necessary to contain the pandemic.
“COVID-19 vaccination should be a condition of employment for all healthcare personnel,” the coalition’s statement reads, warning that “a sufficient vaccination rate is unlikely to be achieved” without a vaccine mandate.
The statement and accompanying guidelines — signed by the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America and five other medical groups — come amid a raging debate about health care, as some organizations impose new vaccine requirements and as infectious-disease expert Anthony S. Fauci suggested last weekend that “there should be more mandates” at the local level to curb virus spread.
Velandy Manohar, MD.,
Distinguished Life Fellow, Am. Psychiatric Association