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Why Are COVID-19 Vaccination Rates So Low Among Nursing Home Staff?

nursing home staffer with resident

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Key Takeaways

  • Fewer than 40% of long-term care facility staff have been vaccinated against COVID-19 despite having access to shots at work.
  • Vaccine hesitancy remains a concern in the U.S., especially among people who live in rural areas and people of color.
  • Linking people who are vaccine hesitant with peers and leaders in their community can help convince them to take the vaccine. 

New research is showcasing an alarming trend: Nursing home staff are not getting vaccinated against COVID-19 at high enough rates, seemingly because of a hesitancy towards the shots. 

According to a study published Monday by the Centers for Disease Control and Prevention (CDC), a median of 37.5% of staff members at long-term care facilities that have provided COVID-19 vaccines have received at least one dose. Comparatively, a median of 78% of residents have received at least one dose of a COVID-19 vaccine.

It’s not a question of supply; both residents and staff of long-term care facilities were prioritized in the vaccine rollout according to guidance from the CDC’s Advisory Committee on Immunization Practices. According to Sarah Berry, MD, MPH, an associate professor at Harvard Medical School and a clinical researcher at Hebrew Senior Life, a long-term care facility in Boston, Massachusetts, the issue is partly cultural.

Berry is an investigator on a clinical trial funded by the National Institute on Aging that is exploring scalable ways to build trust and increase COVID-19 vaccination among nursing home staff. She tells Verywell at least 58% of nursing home staff are people of color—and nonwhite people are chronically underrepresented in the vaccination rollout so far. A January poll of nearly 1,600 people in the U.S. conducted by the Kaiser Family Foundation shows Black adults (43%) and Hispanic adults (37%) remain significantly more likely than White adults (26%) to say they want to “wait and see” before getting the vaccine. 

At a press briefing about vaccine hesitancy last week hosted by the Alliance for Health Policy in Washington, DC,  Reed Tuckson, MD, chair of the Alliance and a former DC health commissioner, cited both distrust of government and distrust of the healthcare system as key reasons why some Black individuals may be refusing the vaccine. 

Tuckson and other Black leaders referenced the deep-seated mistrust that stems from the Tuskegee Experiment, a 1932 CDC study which looked at syphilis among thousands of Black men over a 40-year period, but failed to treat them or inform them they were not being treated so they could leave the study and seek care. 

As a result of not only Tuskegee but decades of inequities in the healthcare system, vaccine messaging won’t necessarily be impactful coming from the government or healthcare professionals. Instead, different trusted messengers are needed to help allay fears about the vaccine to different groups. Tuckson says that goal is behind the creation of the Black Coalition Against COVID, which includes messages and videos with community and faith leaders explaining why they got the vaccine and why others should as well. 

Tuckson calls the Coalition a “grassroots, community-based organization of influencers who can communicate science in their own vernacular,” explaining it has held virtual multicultural town hall meetings. 

Berry agrees that town halls are a critical way to address vaccine hesitancy.  She began organizing town halls with nursing home staff within a week of the Pfizer vaccine being authorized in December. These meetings were staffed with diverse panel members with whom staff could identify. “What has been most helpful at the town halls is people sharing their experiences, and saying ‘when I got my vaccine...’” Berry says.

What This Means For You

If you’re concerned about effects of the vaccine, talk to your doctor, a friend who has gotten vaccinated, or a community leader to ask about their experience.

Despite her efforts, Berry is still concerned about vaccination rates among nursing home staff. 

“There has to be a plan going forward and we don’t have that yet,” she says, explaining high staff turnover and a constant influx of new employees makes vaccine education difficult. 

That education is especially difficult against the backdrop of vaccine misinformation fueled by social media. Berry says she’s heard of rumors ranging from the COVID-19 vaccine causing infertility to the vaccine’s ability to “mark” people and keep them from getting to heaven. 

“Unfortunately, some staff members tend to trust information from their peers better than from their manager or the government,” she says. “My goal isn’t to convince every single person [to vaccinate], but rather to get them good information, and [allow them to] make their decision based on that information and not on what they’re hearing on social media or from a friend.” 

Berry and her colleagues have created a website tailored to helping nursing homes share reliable information on the vaccines.  

Berry and the team at Hebrew Senior Life also participate in a virtual national network of nursing homes launched by the federal Agency for Healthcare Research and Quality (AHRQ) with Project ECHO, a consortium of medical specialists. The network provides guidance from experts, as well as peer-to-peer learning and support, to help nursing homes address challenges like vaccine hesitancy among their staff.

More than half the nursing homes in the country have signed on to participate. 

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  1. Gharpure R, Guo A, Bishnoi CK, et al. Early COVID-19 First-Dose Vaccination Coverage Among Residents and Staff Members of Skilled Nursing Facilities Participating in the Pharmacy Partnership for Long-Term Care Program — United States, December 2020–January 2021. MMWR Morb Mortal Wkly Rep. ePub: 1 February 2021. doi:10.15585/mmwr.mm7005e2