CDC: 30% of Hospital Workers in US Still Unvaccinated

Alicia Ault

November 18, 2021

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Some 30% of healthcare personnel who worked at the thousands of hospitals in the United States were still not fully vaccinated against COVID-19 as of mid-September, according to a new survey by the Centers for Disease Control and Prevention (CDC).

The snapshot in time — January 20, 2021 to September 15, 2021 — is based on voluntary weekly reports from hospitals. Only about 48% of the 5085 hospitals in the US Health and Human Services department's Unified Hospital Data Surveillance System reported data on vaccination coverage during the period, and, after validation checks, the study included reports from 2086 facilities, or just 41% of all hospitals, covering 3.35 million workers.

Overall, the number who were fully vaccinated rose from 36.1% in January 2021 to 60.2% in April 2021, and then crept slowly up to 70% by September 15, the CDC researchers reported in the American Journal of Infection Control.

The slowdown among hospital workers seems to mirror the same decline as in the general population.  

Arjun Srinivasan, MD, associate director for healthcare-associated infection prevention programs at the CDC, said the decline in part may be the result of misinformation.

Healthcare personnel "are not fully immune from vaccine misinformation," he said, adding that such misinformation "is contributing to decreased vaccine uptake among non-healthcare personnel."

"The take-home message is that there is a lot of work to do in healthcare settings in order to get all of our healthcare personnel vaccinated," Srinivasan told Medscape Medical News. "We need them to be vaccinated to protect themselves. It is also really important that we as healthcare personnel get vaccinated to protect our patients."

Vaccine Mandates

The analysis shows that workers were more likely to be vaccinated if they worked at a children's hospital (77%), lived in metropolitan counties (71%), or worked in a hospital with lower cumulative admissions of COVID-19 patients, or lower cumulative COVID-19 cases.

The odds of being fully vaccinated were lower if the surrounding community had lower vaccination coverage. Workers in non-metropolitan counties (63.3%) and in rural counties (65.1%) were also less likely to be fully vaccinated, as well as those who were in critical access hospitals (64%) or long-term acute care hospitals (68.8%).

The study authors report that surveys have shown that healthcare personnel who are vaccine-hesitant cited concerns they had about vaccine efficacy, adverse effects, the speed of vaccine development, and lack of full US Food and Drug Administration (FDA) approval. In addition, many reported low trust in the government.

A Medscape survey this past April found that 25% of healthcare workers said they did not plan to be fully vaccinated. Some 40% of the 9349 workers who responded said that employers should never require a COVID-19 vaccine for clinicians.

But the Centers for Medicare & Medicaid Services is attempting to require all healthcare facilities that receive Medicare or Medicaid payment to vaccinate workers. All eligible staff must receive the first dose of a two-dose COVID-19 vaccine or a one-dose vaccine by December 6, and a second dose by January 4, 2022. The policy allows exemptions based on recognized medical conditions or religious beliefs.

Some hospitals and health systems and various states and cities have already begun implementing vaccine mandates. Northwell Health in New York, for instance, lost 1400 workers (evenly split between clinical and nonclinical staff), or 2% of its 77,000 employees, as a result of the state's mandate.

Northwell's workforce is now considered 100% vaccinated, a hospital spokesman told Medscape Medical News. In addition, "we have allowed for team members who changed their minds and presented proof of vaccination to return," said the spokesman, adding that "a couple of hundred employees have done just that."

Ten states sued the Biden administration last week, aiming to stop the healthcare worker vaccine mandate. Other challenges to vaccine mandates have generally been unsuccessful. The US Supreme Court, for example, in October declined to hear a challenge to Maine's mandate for healthcare workers, even though it did not allow religious exemptions, according to the Washington Post.

"The courts seem to agree that healthcare personnel are different, and could be subject to these mandates," said Srinivasan.

Alicia Ault is a Lutherville, Maryland-based freelance journalist whose work has appeared in publications including JAMA,, the New York Times, and the Washington Post. You can find her on Twitter @aliciaault.

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