Hospital leaders address issue as calls for mandates mount and other systems impose them

JOHNSON CITY, Tenn. (WJHL) – Ballad Health CEO Alan Levine supports the logic and science behind growing calls for health care employers to mandate employee COVID vaccines — but he said the time’s not yet right to make Ballad employees choose between getting vaccinated or losing their jobs.

“I agree fundamentally with what the hospital association is saying and with what other hospital systems are now doing with the mandates, but those systems are in different environments and markets,” Levine told News Channel 11 Wednesday.

Levine referred to the Virginia Hospital and Healthcare Association’s Monday release supporting vaccine requirements. Tuesday, Phoenix-based Banner Health became one of the latest systems to mandate vaccinations — a move affecting 52,000 employees.

Ballad Health CEO Alan Levine and Chief Infection Prevention Officer Jamie Swift discuss the prospect of COVID vaccine mandates for employees at Ballad’s Johnson City, Tenn. headquarters July 21.

And about an hour after the Wednesday interview, the American Hospital Association weighed in supporting mandates.

But Levine said Ballad is walking a tightrope as it works to persuade the 38 percent of its staff that remains unvaccinated to take the jab.

On one side is a large contingent of employees who remain unsure whether getting vaccinated is the right move for them. Many in the nursing force are millennial women with concerns about impacts on childbearing — even though no scientific evidence exists that the vaccines have such an impact.

And those workers are critical right now as Ballad continues to grapple with a serious nursing shortage.

“If today I said, ‘everybody’s required to take the vaccine or you’re terminated,’ then I have a problem being able to take care of people who show up to our ER with strokes, or chest pains, or medical admissions or surgical admissions,” Levine said.

On the other side is the evidence Levine acknowledges is solid and supports universal vaccination in health care facilities with only rare exceptions — and the clear and present danger posed by the delta variant.

“If the delta variant hits staff and we lose staff because they’re sick, or in the hospital with COVID, or they have to go home and quarantine, that’s also going to affect our ability to staff. So I think the outlook for the next 90 to 120 days is concerning on that front.”

“We’re gonna keep pushing, keep pushing, keep pushing, and hopefully we’ll get to a place where we wouldn’t have to make it mandatory. But if it comes to that, then we’ll make whatever hard decisions we have to make.”

Ballad health ceo alan levine on a potential covid vaccine mandate for employees

Those twin threats work in direct opposition to each other. Levine said he’ll rely on Chief Infection Prevention Officer Jamie Swift to keep the system’s prevention protocols at the highest possible level while leaders gauge the balance between the latest COVID wave and the prospect of crucial workers downing tools just when they’re needed most.

Given that prospect, at least on Wednesday, Levine said Ballad was “uncomfortable with a mandate until the FDA has given full approval.”

The FDA is expected to grant full approval before the end of 2021 – possibly sooner. Levine said at that point leadership “can have an opportunity to have another dialogue with our team members.”

But Levine acknowledged plenty of those 62 percent of fully vaccinated team members would like to see a mandate come sooner and aren’t shy about saying so.

“Particularly nurses that have been in the ER ICU or COVID units, they’re wondering when are we going to mandate this, because they’ve seen it, they see it every day, and they’re exposed — some of them are more exposed than others.

Despite unsatisfactory COVID vaccination coverage among its employees, Ballad Health’s CEO said the system isn’t yet ready to follow the lead of numerous other systems and a growing chorus of organization’s recommendations by mandating employee vaccinations.

“So I think if a decision were to be made to make it mandatory I think there would be some people that would oppose that decision today but I think the vast majority would support it.”

Hoping the ‘right time’ will come soon

Swift’s role allows her to be much more focused on prevention. And the seven national societies centered around epidemiology, infection control and the like that released a joint July 9 statement calling for mandates are right in her wheelhouse.

“I concur with the recommendations, and it was the same thing when we were talking about flu mandates,” Swift said.

“There are large organizations that I trust every single day – SHEA and APIC I’m a member of, and when those organizations come together with that statement then I really want to use that to arm people to make their best decisions.”

She pushed for mandates and those eventually came. In this case, she’s continuing to use the bully pulpit and persuasion even if she may be pushing other leaders privately to consider a mandate.

“I want them (leaders like Swift) to advocate their position on this because it helps inform the best possible decision for the system,” Levine said. “I don’t expect Jamie to agree with all of my decisions, but I expect that she will tell me everything I need to know.”

Swift said she’ll keep beating the drum.

I’ll continue to really share the information,” she said. “That’s what I do on social media, that’s what I do with the people that I talk to.”

Occasionally the message is still getting through — but not very often these days, Levine and Swift concede.

“We are still actively engaging our team members between now and the mandate,” Swift said. “I had a discussion yesterday with a team member who wanted more information, we were able to talk and they made that decision to go get that vaccine.”

But the multi-society white paper said no system should count on reaching the 90-percent plus level through persuasion alone.

“Prior experience and current information suggest that a sufficient vaccination rate is unlikely to be achieved without making COVID-19 vaccination a condition of employment,” the paper states.

A chart from July 20 shows the impact the delta variant of COVID-19 is beginning to have on area hospitalizations.

Levine is still holding out hope that after one-on-one conversations, combined unfortunately with what he said is the coming impact of the delta variant, “people are going to reassess this.”

If not enough Ballad employees do, several things could tip the system toward a mandate.

“I think the dynamics could change when you see a threat that comes closer to the team members as the delta variant becomes more apparent in the community and I think when you see the FDA make definitive decisions about permanent approval, the conversation does change,” Levine said.

In the meantime the system continues universal masking in public areas at its facilities, whether someone is vaccinated or not.

“There’s a lot going on out there in conjunction with vaccine to make sure we’re doing everything we can to keep our team members safe,” Swift said.

Levine said Ballad is taking a page from a large physicians’ group playbook. They’ll poll for the top five reasons people aren’t getting vaccinated then give evidence and data refuting each of those reasons.

“You don’t win an argument by withholding facts, you win an argument by giving all the facts and then trusting people to make the best decision,” he said. “And we do believe that the vaccine is the right decision for people.”

And if uptake remains slow and a significant number of employees aren’t “prepared to have that conversation?”

The multi-society paper addresses the legal considerations this way:

“There is long-standing constitutional support for vaccine mandates, and many state laws also support such mandates. According to published guidance of the Equal Employment Opportunity Commission (EEOC), the federal civicl rights laws it enforces do not prevent an employer from requiring employees to be vaccinated for COVID-1, subject to a limited set of legally required exceptions…”

Levine didn’t sound like he’d be afraid to “go there” if necessary.

“We’re gonna keep pushing, keep pushing, keep pushing, and hopefully we’ll get to a place where we wouldn’t have to make it mandatory. But if it comes to that, then we’ll make whatever hard decisions we have to make.”