Coronavirus disease 2019 (COVID-19) vaccination rates and staffing shortages among healthcare personnel in nursing homes before, during, and after implementation of mandates for COVID-19 vaccination among 15 US jurisdictions, National Healthcare Safety Network, June 2021–January 2022

Abstract

Objective: To examine temporal changes in coverage with a complete primary series of coronavirus disease 2019 (COVID-19) vaccination and staffing shortages among healthcare personnel (HCP) working in nursing homes in the United States before, during, and after the implementation of jurisdiction-based COVID-19 vaccination mandates for HCP. Sample and setting: HCP in nursing homes from 15 US jurisdictions. Design: We analyzed weekly COVID-19 vaccination data reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network from June 7, 2021, through January 2, 2022. We assessed 3 periods (preintervention, intervention, and postintervention) based on the announcement of vaccination mandates for HCP in 15 jurisdictions. We used interrupted time-series models to estimate the weekly percentage change in vaccination with complete primary series and the odds of reporting a staffing shortage for each period. Results: Complete primary series vaccination among HCP increased from 66.7% at baseline to 94.3% at the end of the study period and increased at the fastest rate during the intervention period for 12 of 15 jurisdictions. The odds of reporting a staffing shortage were lowest after the intervention. Conclusions: These findings demonstrate that COVID-19 vaccination mandates may be an effective strategy for improving HCP vaccination coverage in nursing homes without exacerbating staffing shortages. These data suggest that mandates can be considered to improve COVID-19 coverage among HCP in nursing homes to protect both HCP and vulnerable nursing home residents.

Influenza and Up-to-Date COVID-19 Vaccination Coverage Among Health Care Personnel — National Healthcare Safety Network, United States, 2022–23 Influenza Season

“…During the 2017-18 and 2018-19 influenza seasons, influenza vaccination coverage among HCP in acute care hospitals was 88.6% and 90.0%, respectively (6). From November 2021 to June 2023, CMS required all HCP at CMS-certified facilities to be vaccinated for COVID-19*****; this requirement likely contributed to COVID-19 primary series vaccination coverage reaching 94.3% among HCP in nursing homes (7) and 91.2% among those at acute care hospitals (5). The current findings suggest that factors associated with low vaccination coverage might have been exacerbated by the COVID-19 pandemic and compounded by emerging concerns such as vaccine fatigue (8) and other as yet unidentified factors.…”

“…Implementation of vaccination recommendations for HCP has been a longstanding challenge for the public health and health care sectors. In an effort to improve vaccination coverage among HCP, health care facilities and federal and state governments have implemented interventions including jurisdiction-wide and facility-wide vaccination mandates (7,9). Mandates for HCP to receive influenza vaccination have been in place since before the COVID-19 pandemic and might contribute to the high vaccination rates reported to NHSN.…”

Promoting Public Health with Blunt Instruments: Evidence from Vaccine Mandates

“…COVID-19 vaccine mandates in the U.S. also show a positive impact on the general population's vaccination rates, with effects appearing as early as three weeks following the mandates' implementation dates (Howard-Williams et al, 2022;Okpani et al, 2024). McGarry et al (2022) and Reses et al (2023) study the effect of these mandates in 15 states using the National Healthcare Safety Network and suggest that these mandates increase the COVID-19 vaccination rate among healthcare workers in nursing home facilities, but with no observed impact on staff shortages. Earlier studies also show that state influenza vaccination requirements for hospital workers 1995-2017 increased the vaccination rate among healthcare workers by 4.2% (Lindley et al, 2019), and reduced pneumonia and influenza mortality rates by 2.5% (Carrera et al, 2021).…”