A dispute is dividing a small but vocal percentage of the workers at New York state hospitals and nursing homes, although a majority of employees have received a COVID-19 vaccine. In a report last week by The New York Times, some healthcare professionals were profiled protesting the state’s vaccination mandate, with some saying they are willing to lose their jobs rather than get a vaccination. While these reports focus on how mandates may make healthcare workers leave or quit their jobs rather than get vaccinated, this debate affects more than the healthcare workers who threaten to leave—there are patients, often from historically disadvantaged communities like disabled, LGBTQ+, and people of color, that run the risk of being further left behind.
According to reports by state and healthcare industry officials, although some of the healthcare workers protesting have yet to get vaccinated, many have acquiesced to the mandate. Last week, 82% of the state’s nursing home workers and about 84% of hospital workers had received at least one dose. That figure rose to 92% at the same time as the vaccination mandate went into full effect Monday in the state’s 650,000-plus hospital and nursing home workers. But as of the deadline for healthcare employees to receive the jab, some workers inevitably quit or were fired, leading some hospitals to postpone surgeries and stop accepting intensive care patients from other facilities.
While most medical facilities affected haven’t released the exact numbers, one small hospital in upstate New York reportedly halted delivering babies because 6 nurses—one-third of their maternity staff—quit over the vaccination mandate.
People who are already fighting against disparate healthcare treatment warn that healthcare workers quitting or leaving the industry because of mandates has broader implications both for the care patients will receive, and their own trust in the vaccine.
“A dearth of clinicians will lead to increased burden on the system and increase the likelihood of discrimination, and inevitably will increase morbidity and mortality for those who are most vulnerable,” said Dallas Ducar, CEO of Transhealth Northampton, an independent trans healthcare center that provides gender-affirming care to trans and gender-diverse adults, children, and families. “We need more clinicians who are not only able to treat disease, but also affirm patients. Less staffing will inevitably result in less patient-centered care. Those who are most vulnerable are the most likely to be discriminated against.”
Healthcare discrimination is rampant, especially for trans and gender-diverse people of color. A 2021 systematic review in JAMA Network found that trans youth included in multiple studies experienced pervasive stigma and discrimination in health care, even when medical facilities were presumably fully staffed. Recent research published by the Center for American Progress found more than half of all transgender and gender-diverse people of color of all ages experience healthcare discrimination.
The system itself also has been guilty of underserving vulnerable patients. An algorithm called Optum, which predicts which patients will benefit from extra medical care, dramatically underestimated the health needs of the sickest Black patients, according to a 2019 study by the journal Science. This algorithm guided decision-making for the care of millions of people, and the study estimated that correcting its bias would more than double Black patients flagged for care. Increased discrimination in primary care settings, where a national survey conducted by the African American Research Collaborative and the Commonwealth Fund found 44% of Latinx and 53% of Black respondents would prefer to get vaccinated, increases the likelihood of those individuals not engaging with the healthcare system and waiting to receive care—oftentimes when it can be too late.
“Clinicians, and specifically primary care clinicians, have a duty to not only treat and inform but also affirm every single patient,” Ducar said.
“Even individuals who have a deeper knowledge of their health still rely on healthcare workers for advice on important medical decisions like vaccinations,” said William Chum, a New York City-based AAPI psychotherapist focused on LGBTQ+ individuals.
Nurses who have been vaccinated have said that they’ve had to battle misinformation from within their own ranks while on the job, even losing some of these unvaccinated colleagues to COVID-19. Further, once the Food and Drug Administration fully approved the Pfizer-BioNTech vaccine in August, a medical exemption for the vaccine became harder to come by and led some anti-vaxxers to accuse the Pfizer vaccine of profiteering. They went so far as to compare life-saving drugs for HIV/AIDS, a disease which disproportionately affects disadvantaged communities, particularly of color, of creating a business out of keeping people with HIV alive, just like the COVID vaccine keeps people alive. Rhetoric like this runs the risk of further increasing distrust and discrimination against HIV+ individuals.
“When a trusted nurse or physician expresses their unfounded opinions on the science, that ripple effect can impact the patient populations’ perspective on the objective data,” Chum said. “This debate runs the risk of creating a harmful distrust in the foundation of scientific and medical research, leading to inevitably poorer health outcomes, especially for BIPOC individuals.”