Immunocompromised patients fear vaccine exemptions will put them at risk

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Charlie O’Neill received part of her husband’s liver in a living donor transplant in 2013 and has been taking drugs that suppress his immune system ever since to prevent his body from attacking the organ.

“I often get infections,” she says. “As an immunocompromised person, you deal with every little cold and flu.”

O’Neill lives in the small town of Pony in the Madison Valley of southwestern Montana. Although he lives in an uncrowded rural setting, O’Neill said, the first year of the coronavirus pandemic was terrifying. She rarely left the house, waiting for COVID-19 vaccines to become available.

Even now, after being vaccinated, O’Neill said the virus was still on her mind when she traveled to nearby Bozeman to pick up groceries and other basic needs. She wears a mask and avoids people as much as she can. While vaccinations offer robust protection against hospitalization and death for the typical individual, they are much less effective in immunocompromised people.

O’Neill developed abscesses on his liver, requiring daily visits to Bozeman Hospital for antibiotic infusions. In a state where the governor has encouraged health workers to seek vaccination exemptions, she worried about which of the many people involved in her care put her at greater risk: the people checking her in at the front desk, traveling nurses, staff imaging technicians?

Gov. Greg Gianforte’s office estimates that “thousands of health care workers” have been granted religious exemptions and are “remaining in the workforce,” according to a recent press release.

“I often ask people so boldly if they’re vaccinated, especially if I have to take off my mask for MRIs or something,” O’Neill said. She said she would ask someone else if a worker told her they weren’t vaccinated or refused to answer, but that didn’t happen.

Most medical personnel across the United States must now be fully vaccinated against COVID-19 under a federal rule from the Centers for Medicare & Medicaid Services. While, by law, requests for religious or medical exemptions must be allowed at every facility, in much of the country they are carefully considered and judiciously approved. In the public system of 12 hospitals in New York, for example, 100% of the staff members inside the hospitals are vaccinated; the few people who have obtained exemptions are assigned to outside duties.

But in Montana, the pendulum swung in a different direction.

Gianforte, a Republican opposed to the federal mandate, encouraged health workers to apply for religious exemptions before the Feb. 14 deadline to receive a dose of the vaccine. His administration provided advice to hospitals That said, the validity of healthcare workers’ religious beliefs should not be questioned in seeking exemptions. Gianforte also asked the state health department to create an app to religious exemptions, which is posted at the top of its website for download.

When asked for an interview with Gianforte, spokesperson Brooke Stroyke referenced the governor open letter to health workers dated February 10.

“The State of Montana will continue to pursue its claims that the warrant is unconstitutional or otherwise unlawful in the district and appellate courts,” the letter read. “In the meantime, however, I urge those of you who are unvaccinated to consider using the religious and medical exemptions your employers are required to offer, as well as speaking to your co-workers or supplier. health care providers the opportunity to be vaccinated.”

The Equal Employment Opportunity Commission stated that employers should presume that a request for a religious exemption is based on sincerely held beliefs, but that if there is an objective basis to question the request, the employer is justified in making a limited factual inquiry .

There is no way to know how many healthcare workers remain unvaccinated in a facility. Many hospitals across the state are unwilling to share the data.

Of nearly 65 hospitals statewide, 11 have shared their exemption rates with Montana Public Radio, Yellowstone Public Radio and KHN. These rates range from less than 1% at two critical access hospitals operated by the US Indian Health Service to 37% at Prairie Community Hospital in Terry. Four establishments said that a quarter or more of their workers had exemptions.

Prairie Community Hospital CEO Burt Keltner said he does not question the exemption requests because losing nearly 40% of his staff would cause the hospital to close.

“Some of the people who chose not to get vaccinated were some of our best employees,” he said.

Montana Hospital Association CEO Rich Rasmussen said one of the reasons most hospitals are wary of sharing numbers of unvaccinated workers is a law passed last year prohibiting discrimination based on vaccination status. Hospitals are concerned that even providing percentages of unvaccinated workers will cause them legal problems, he said.

Centers for Disease Control and Prevention spokeswoman Martha Sharan said the agency will soon release national vaccination rates for medical staff at CMS-certified acute care hospitals. She added that the dashboard could potentially include national data from other medical institutions participating in certain CMS programs.

CMS will post facility-level vaccination rates for those facilities on its Compare treatments website in October, CMS spokeswoman Beth Lynk said.

An analysis of data voluntarily reported by the CDC found that 70% of staff at medical facilities nationwide were vaccinated by mid-September, but noted that lower vaccination rates were likely in rural areas. That was before the Biden administration announced the CMS vaccine mandate, and rates have likely increased since.

Paul Conway, president of policy and global affairs at the American Association of Kidney Patients, said the lack of transparency regarding COVID-19 vaccination rates for medical workers puts immunocompromised patients in a bind.

“During COVID, if you are in a dialysis center where you are there for hours, you have blood exchanged, you are surrounded by many different workers, you are surrounded by many different patients, your susceptibility is very high”, he explained.

A University of Michigan study found that a quarter of patients on dialysis died if they had contracted COVID-19. This study used data from 2020, when vaccines were not available until December.

Conway said the kidney patients’ association wants CMS to publicize vaccination rates for hospitals and dialysis centers to help patients make informed decisions. But for now, he says, they are alone. This puts them in the awkward position of asking caregivers about their vaccination status at a time when it is a loaded issue in much of the country.

“Patients always have the right and freedom to ask the question and likewise doctors and nurses also have the freedom to answer the question or not,” said Joel Wu from the University of Minnesota Center for Bioethics. “I think it’s important to answer the question honestly because I think it builds trust.”

Roger Gravgaard, a 62-year-old kidney transplant recipient from Billings who is a patient advocate for kidney disease organizations, said unvaccinated staff members need to understand there are real consequences for patients like him. He is grateful to all of his providers for getting vaccinated without him even having to ask, he said.

“I feel better knowing they’re vaccinated and I hope they feel the same knowing I’ve been vaccinated because it’s a two-way street,” he said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.

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