A needle is filled with vaccine ahead of a shot. Courtesy of NIH

In late summer, multiple hospital systems told their workers to vaxx up or pack up.

Hundreds of thousands of North Carolinians have volunteered to get vaccinated against COVID-19. To date, more than 5.7 million state residents have gotten two doses of the Moderna or Pfizer jabs or the single-dose Johnson & Johnson vaccine.

Starting in July, several hospital systems announced a COVID-19 vaccine requirement. Many hospital employees were vaccinated before their hospitals required shots as a condition of employment.

According to two of the state’s largest hospital organizations that responded to queries from Carolina Public Press, they have also granted some workers an exemption from the vaccine mandate as long as they are frequently tested for the coronavirus and wear appropriate personal protective equipment such as N95 masks or face shields.

Two additional hospital systems did not respond to Carolina Public Press’ survey, and two more responded without revealing how many workers are utilizing exemptions to the vaccination mandate.

Reasons for exemptions vary. Some people can’t get the shot due to their allergies. Others have received a religious exemption. 

Earlier in the pandemic, pregnant women also eschewed vaccination. More recently, the Centers for Disease Control and Prevention said the evidence shows pregnant women are at increased risk for COVID-19, and vaccines are safe for women who are pregnant, breastfeeding or trying to conceive.

Meanwhile, the Centers for Medicare and Medicaid Services recently entered the rule-making stage of developing a nationwide COVID vaccination mandate for all health care employees who work in Medicare- or Medicaid-funded facilities. While initially this related to long-term care facilities, the mandate is expanding to hospitals, surgical settings and dialysis centers.

More than 2,500 hospitals nationwide have made vaccination a requirement of continued employment, according to Becker’s Hospital Review.

Workers who lose their jobs because they refuse to comply with a vaccination mandate are entering a favorable job market or may be able to claim unemployment benefits.

Novant Health announced a vaccine mandate in July, along with many other hospitals in the state, and asked its 35,000 workers to get the jab by the middle of September.

And while the vast majority of workers have complied with that mandate, around 375 workers were suspended until they got vaccinated. 

Of those, 200 got vaccinated within the next five days, said Novant spokeswoman Megan Rivers, on Twitter.

Ultimately, Novant fired 175 people for refusing to get a valid exemption or get vaccinated.

Workers with an approved medical or religious exemption “are required to undergo weekly COVID-19 testing, wear N95 respirators masks or other appropriate PPE, and eyewear protection while working on Novant Health premises,” Rivers said in response to CPP’s survey.

The system did not answer how many people received an exemption.

Hospitals are requiring vaccinations for a number of reasons. Several mentioned patient safety and the bedrock principle of doctors to “do no harm.” 

Workforce protection is also on the minds of executives as the pandemic enters its 19th month and nearly 730,000 people in the United States have died from the disease.

“Vaccination also prevents our team members from getting COVID,” said Dr. David Priest, Novant’s senior vice president and chief safety, quality and epidemiology officer, during a recent media briefing.

Before vaccines were available, workers who contracted COVID had to isolate at home for up to a couple of weeks, Priest said. In that context, the 175 people who were fired for refusing the vaccine is a comparatively small number.

In all 14 state-operated health care facilities, nearly all of the 10,000 workers have been vaccinated, the state Department of Health and Human Services announced last week. By the end of June, more than 3-in-4 state health care workers had already been vaccinated. The state mandated a COVID vaccination for its health care workers in July, with a deadline of Sept. 30.

Of those 10,000 workers, roughly 6%, or 600 people, received a valid exemption from the policy for medical, religious or other accommodations consistent with the Americans with Disabilities Act. 

Sixteen workers were fired for not complying with the mandatory vaccination requirements, the state said in a press release.

Of the roughly 30,000 workers at UNC Health, nearly all have been vaccinated, and only 1,250 have medical or religious exemptions, said spokesman Alan Wolf in response to CPP’s survey.

Through the entire UNC hospital system, about 95 employees resigned and cited the vaccination requirement as the reason for their departure, he said. Workers at UNC hospitals around the state had until late September to get vaccinated or receive an approved exemption.

At Vidant, receiving the COVID vaccine is now a condition of employment for around 14,000 workers. So far 99.6% of managers and their bosses, physicians and credentialed providers have been vaccinated, said spokesman Brian Wudkwych. Roughly 81% of all other workers have been vaccinated. They have until Dec. 1 to get the vaccine.

Vidant did not reveal how many unvaccinated but exempted employees will continue to work there. 

However, Wudkwych characterized it as a “small number,” and said, “Requirements for those who receive approved medical/religious exemptions may include periodic COVID-19 testing, remote work and/or potential reassignment from working on units with immuno-compromised patients.”

WakeMed and Atrium Health did not respond to CPP’s survey.

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Kate Martin is lead investigative reporter for Carolina Public Press. Email her at kmartin@carolinapublicpress.org.