Healthcare workers were more likely to get the COVID-19 vaccine in states that implemented vaccine mandates during the pandemic, new research has confirmed.
Researchers said the findings could prove helpful for future long-term care policy decisions and how to respond in the event of another pandemic.
Results, which appeared Wednesday in JAMA Network Open, lend support to previous research on the efficacy of vaccine mandates in increasing COVID vaccinations among nursing home workers, especially younger ones.
Researchers from the Department of Health Policy and Management at the Tulane University
School of Public Health and Tropical Medicine, sought to determine if state COVID-19 vaccine mandates for healthcare workers were associated with increased vaccine uptake for those workers in 2021.
Using data from the Household Pulse Survey, the investigators studied 31,000 healthcare workers from 45 states — 16 of which instituted COVID-19 vaccine mandates for healthcare workers in mid-2021.
The mandates were associated with a 3.46 percentage point increase in the proportion of workers ever vaccinated against COVID-19 and a 3.64 percentage point increase in the proportion who completed or intended to complete their primary vaccination series, comparing mandate states to non-mandate states.
“This repeated cross-sectional study found that state COVID-19 vaccine mandates for HCWs were associated with increased vaccine uptake among HCWs, especially among younger HCWs and those in states with no test-out option,” the authors wrote. “These findings suggest the potential for vaccine mandates to further promote vaccinations in an already highly vaccinated HCW population, especially when no test-out option is in place.”
Avoiding economic ‘meltdown’
One of the most interesting discoveries was the high overall vaccination rates among healthcare workers, which were in the 86%-87% range, and that the states with vaccine mandates helped push those rates even higher, said Charles Stoecker, PhD, corresponding author of the study and an associate professor in the Department of Health Policy and Management at Tulane.
“Nobody likes mandates,” Stoecker said. “A lot of people have quit their jobs because of this. On the other side of the equation, you could have an economic meltdown if there’s another pandemic. That’s not an exaggeration. We all know what happened during COVID.
“If you’re in a pandemic and you’re faced with an economic meltdown, this is a good way to increase vaccination rates,” he added.
Stoecker noted that many nursing homes and hospitals implemented their own company vaccination mandates for healthcare workers to prevent the spread of COVID and other diseases.
“Nursing homes and hospitals are places where people are particularly vulnerable,” he noted. “Anywhere you get healthcare can make you particularly susceptible to COVID.”
The researchers say their findings support other research that found that COVID-19 vaccine mandates boosted vaccination rates for nursing home employees. Stoecker said their study looked at the broader healthcare workforce, including nursing homes, hospitals and other healthcare facilities.
“Our results showed rapid effects of COVID-19 vaccine mandates, as also evidenced by prior
research on mandates for nursing home workers in the US and vaccine passport mandates in
Canada and Europe,” study authors explained. “These studies found that vaccine uptake among specific populations rose immediately in the first few weeks following mandate announcement.”
Not surprisingly, vaccine mandates were most effective in states where there was no test-out option.
“The study demonstrated the potential for vaccine mandates to further promote vaccine uptake among a broadly vaccinated population, especially when a level of mandate stringency is maintained,” they concluded.
Seventeen states enacted COVID-19 vaccine mandates for healthcare workers prior to the implementation of a federal rule mandating COVID-19 inoculations, which was announced in November 2021. The US Supreme Court eventually upheld the controversial rule in 2022; the federal mandate on COVID vaccinations for healthcare workers was lifted after the COVID public health emergency ended in May 2023.
