I Work in a Nursing Home. Here's Why My Colleagues Are Skipping the Vaccine.
By Asif Merchant, The Washington Post
14 February 21
In almost two decades working in nursing homes, I've never been through a
time as dire as last spring. Facilities like mine, in the greater Boston
area, were working with minimal to no protective gear, very little
infection-control training, limited laboratory services and constantly
changing public-health guidelines. Residents with covid-19 deteriorated so
quickly that they'd crash right in front of me, before we even got their
test results.
Staff members got sick, and others stayed home because they were scared to
get sick. While many doctors stopped going into nursing homes out of fear
for their own safety, my team of physicians and nurse practitioners felt it
was our duty to continue seeing patients every day. The need was so great:
Units that usually had one certified nursing assistant for every eight to 10
residents suddenly had one person in charge of 30 to 40; we were also short
on nurses. People weren't getting their meals or personal care on time; they
suffered from dehydration, bedsores and social isolation. It was a
heartbreaking time. I lost over a hundred patients.
As we learned more about the virus - treatments, proper infection control -
conditions improved. Then the vaccine offered our first real hope that this
pandemic would eventually end. I got my shots in January, as soon as I
could.
But I soon realized that not everyone shared my enthusiasm. About half the
staff in the four facilities where I serve as medical director said they
would not take the vaccine. This might seem shocking: We work in the medical
field, and we saw some of the worst ravages of this disease up close. And
yet, despite the misery we'd witnessed, my colleagues were wary of the one
intervention that offered a light at the end of the tunnel.
Health authorities across the country have reported widespread vaccine
hesitancy among nursing home staff. Uptake among residents is high. But a
national survey of certified nursing assistants late last year found that
nearly 72 percent didn't want to be vaccinated. The governor of Ohio
reported in late December that around 60 percent of his state's nursing home
staffers had elected not to take the vaccine yet. Last month, a union
representing nursing home staff in Maryland and D.C. estimated that up to 80
percent of its members opted not to be vaccinated in the first push at their
facilities. One Miami health system found that only half its employees
wanted to get vaccinated immediately; about 15 percent said they were not
interested in getting vaccinated at all.
Those statistics are much less surprising when you consider who works in
nursing homes. A lot of the certified nursing assistants I work with are
people of color. Their mistrust has deep roots: The United States has a
long, ugly history of doctors experimenting on Black people without regard
for their consent or needs. And working with the elderly - another
population our society marginalizes and neglects - has done little to shore
up my colleagues' faith that the government is acting in their best
interests. Nursing homes were among the first and hardest-hit settings in
this pandemic, and we never had enough N95 masks or even simple surgical
face coverings. So when nursing home employees are informed that they'll be
among the first to get the vaccine - that they're in the highest-priority
group - they're skeptical. It doesn't help that many of the most widely
available educational materials about the vaccine are produced only in
English, shutting out my co-workers who primarily speak Spanish or Haitian
Creole.
I started running town halls, in person and over video, to talk to the staff
in various Massachusetts nursing homes about the vaccine. Some people come
with questions about their specific situations: autoimmune conditions,
allergies to food or medicine, pregnancy. I've heard more lurid worries,
too. Some people thought the shot had a GPS tracker in it that would allow
the government to follow their movements. Others claimed that the vaccine
changed your DNA and that any future children could inherit the mutation.
No matter how outlandish some fears seem, I can't shrug them off. People's
concerns aren't totally random; it's counterproductive to just dismiss them.
Instead, I try to figure out where their understanding went wrong and to
offer an explanation for that misunderstanding. For example, vaccines
definitely don't contain GPS-enabled chips, but the Pfizer boxes carrying
the doses do have a tracking device so that we can follow shipments to our
facilities. After I show the staff videos of the boxes and their bar codes,
that seems to assuage their fears. I also talk about the differences between
RNA and DNA - people often confuse the two, I say, but the vaccine won't
affect the latter.
Some people have more general concerns: Did some stringent standard fall by
the wayside to speed up the development and approval process? A nurse asked
me: "So, Dr. Merchant, was there any point in time when you didn't want to
take the vaccine? And at what point did that change?" It helped, I think,
that I could answer honestly: Yes, I was skeptical, especially in the spring
of 2020. It seemed like President Donald Trump was making unrealistic
promises about the timeline for a vaccine and the whole development and
approval process might be politicized. But as more data emerged about the
vaccines' efficacy, and as I read up on their safety, the more I trusted the
science behind them.
I also talk about why I took the vaccine: I see covid-19 patients every day.
I got the shot to protect myself, of course, and to protect my family
members - especially my parents, who are elderly and live at home with me. I
also want to keep my nursing home residents and co-workers safe; I have a
responsibility to my community. And, I add, I'm tired of all the precautions
that have become life-or-death necessities in the pandemic. We all want
normalcy. Vaccine uptake is our ticket there.
These conversations are incredibly time-consuming - hours that I could've
used elsewhere, seeing to patients - but they're worth it. Usually, at the
end of the town halls, at least a couple of staff members will say they now
feel more comfortable with the vaccines. Others say that they'll at least
consider taking it, or that they don't want to be the first in line but
they'll get the shot the next time it's available to them. When you talk to
people, when you take them seriously, you can change their minds. I really
believe that. I have to believe it.