Credit: Darrow Montgomery

A dental office manager who became extremely ill from COVID-19 at the start of the pandemic declined initial chances to get the vaccine because he worried about the side effects. He also doubted that he would get infected again. A program director at a health center whose son got COVID-19 initially said no to the vaccine because she needed time to decide whether she felt it was safe. “Where did this come from? What’s going in my body? Will it hurt me later?” she wondered.   

Many people assume that individuals working directly or indirectly in health care fields will not only be accepting of the COVID-19 vaccine, but eager to get it. Some of these workers know just how lethal the coronavirus can be. The death count isn’t just numerical to them—they’ve seen the pathogen destroy lives. Still, not every worker in a health care setting has been vaccinated despite being eligible to get the shot in D.C. for months. This hesitation or unwillingness to get the shot can’t just be chalked up to COVID-19 denial. 

The dental office manager, Vicente Torres, declined when he was offered the vaccine in January. At the time, he was more certain of reinfection being rare than of the side effects from the vaccine. He didn’t know anyone who had been vaccinated at the time. When he contracted COVID-19, he didn’t know anyone who tested positive. But unlike with vaccination, he had no control over getting sick. 

Torres tested positive for COVID-19 in March 2020, when little was known about the virus and people were afraid of catching something from touching surfaces. He wasn’t hospitalized, but he says he had never been that sick before. He ran a fever and lost his sense of smell and taste for a week, and had a lingering cough for a month. Getting sick also meant he nearly missed being in the room for the birth of his daughter. His 14-day quarantine ended just before his girlfriend delivered their baby.  

Less than a year later, his employer, Mary’s Center, offered him a vaccine that experts said could prevent serious illness or death. The D.C. government selected Mary’s Center, a federally qualified health center, to administer the shot to frontline workers. Torres weighed the risk of reinfection against the side effects and said no. He ended up getting the shot almost a month later, once some of his colleagues had gone through the process and he could see how they reacted. In the interim, Torres was also able to get his specific questions answered from one of the center’s medical directors. After learning more about the Pfizer and Moderna vaccines and feeling compelled to protect his family, Torres decided to go with Moderna.  

“Even though I saw that the risk of reinfection was low, I still wanted to get the vaccine to try to prevent getting COVID and passing it on to my daughter,” Torres says. “All the symptoms that you can get from COVID are a million times worse than having symptoms from the vaccine.” (He only had a sore arm and a slight fever after inoculation.) 

Mayor Muriel Bowser’s administration prioritized health care workers and first responders when the federal government started sending DC Health shipments of the vaccine late last year, and some got offered the shot as early as mid-December. Five months in, roughly two-thirds of those workers are vaccinated, according to DC Health testimony and accounts from various employers. The numbers could be higher, since not every employer requires workers to report their vaccination status. In D.C., daily shot counts have dropped, just as they have nationwide.   

Recognizing that each person has their own reason for continuing to decline the vaccine, employers of frontline workers are exploring ways to convince the holdouts. One-on-ones? Bonuses? Mandates? The Bowser administration is also considering incentives, including monetary ones. The administration already offered free beer at one vaccine site last week; 162 people who attended got vaccinated. 

Meanwhile, workers such as Torres who changed their minds stress the importance of having a trusted source listen and answer questions. Workplaces that foster open dialogues, especially around the coronavirus, have an edge. People may feel even less comfortable asking questions nowadays because the assumption is everyone who hasn’t gotten vaccinated yet has made up their minds. “I’ve heard comments from people [saying], ‘Oh, I have dumb questions,’” Torres says. “There’s no such thing as dumb questions, especially with something as big as the vaccine.” He wears an “I vaccinated” sticker on his ID badge to encourage his colleagues.

Photo of Vicente Torres by Darrow Montgomery

Getting as many frontline workers as possible vaccinated helps D.C. build immunity and slow infections, but what is many? “We should all be striving toward the current federal goal of 70 percent vaccinated,” says Dr. Keri N. Althoff, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. “That is a good first goal.” She says vaccination coverage should be even higher for health care workers and first responders because they are potentially exposed to COVID-19 on a daily basis as a part of their jobs.   

Overall coverage among health care workers and first responders appears to be below 70 percent, as of mid-May. That coverage estimate may not be not entirely accurate because it’s based on personal testimony and workplaces don’t mandate that employees share their vaccination status. Some employers, such as Whitman-Walker Health, ask their workers for this information so they could enforce CDC guidelines, which eases quarantine and testing requirements, among other things, for fully vaccinated people. According to Whitman-Walker Health, 75 percent of their workers are fully vaccinated.

When asked what coverage among health care workers looks like, Dr. Ankoor Shah, DC Health’s vaccine lead, told the Council at an April 29 hearing that 63 percent of workers at D.C.’s federally qualified health centers are fully vaccinated. He suspects other health care providers have similar rates. “That is similar across other employee groups and demographics,” Shah told Ward 7 Councilmember Vince Gray, who chairs the health committee, during the hearing. “We hit kind of a wall once you get somewhere between 60 to 75 percent, or you have to do a lot more engagement.” Gray’s office requested but did not receive any more data on vaccinations among health care workers. A DC Health spokesperson says updated data is not available.  

Coverage for the D.C. Fire and EMS Department is comparable and has not budged in recent weeks. Roughly 1,300 members, or 62 percent, are fully vaccinated, according to Doug Buchanan, the department’s chief communications officer. Firefighters and first responders who remain uncertain have lingering questions, including about the side effects and mRNA, the technology behind the Pfizer and Moderna vaccines. Some also don’t trust the emergency regulatory process behind approving the vaccines, or the government for that matter. “Pretty much anything you read on the Internet, I think we’ve heard,” says FEMS Chief John Donnelly

“I would like to be at 100 percent,” Donnelly says of his department’s coverage. “I also recognize at the same time that our workforce is a microcosm of society, and it’s probably an unreasonable goal to be at 100 percent when we’re not going to get the whole country to 100 percent. But we’re going to keep working on it.”  

Despite some experts believing there is legal authority to require vaccination, few employers in D.C. are ready to make that leap, including those of frontline workers. Donnelly is not mandating that his members be vaccinated. “If it were mandatory, our members would generally comply,” he says. No hospital is conditioning employment on vaccination, according to Jennifer Hirt, the spokesperson for the D.C. Hospital Association.  

Instead, the focus among employers of frontline workers has been to reach out to workers who are not yet vaccinated, learn what concerns they still have, and reiterate what scientists know in layman’s terms. Employers have also leaned on workers who’ve already gotten the shot to help their cause. Sometimes, they’ll have them share their stories via social media or internal email. Other times, workers are speaking out about their experiences in staff meetings. 

Community of Hope, a federally qualified health center that’s administering doses, is currently surveying staff to better understand vaccine hesitancy and to identify strategies that could change opinions. According to CEO Kelly Sweeney McShane, 61 percent of her staff is vaccinated. This includes administrative staff and case managers. Coverage among health care workers at Community of Hope is higher, at 71 percent. The health center is not requiring proof of vaccination, so the data is gleaned from workers getting vaccinated on site or independently offering this information.  

McShane believes some are concerned that the rollout happened too quickly and others want to wait a bit longer because they don’t trust the health system. Community of Hope’s staff is majority Black, so medical racism plays a factor, says McShane. “We definitely have had staff test positive for COVID. We currently have staff who are testing positive for COVID. I would say most of that does not appear to be work-related,” she adds. “Despite that, we still don’t have everyone vaccinated. So there’s still underlying questions that people have as they are weighing the risk of a vaccine versus the risk of COVID.” 

Despite COVID-19 hitting firefighters and first responders hard, a significant number are not yet inoculated. Of the 432 members who have tested positive for COVID-19, 35 have either been admitted to the hospital or seen at the emergency room. The department is optimistic that if they compare these stats to the vaccine’s—1,300 members have gotten the shot and only two have visited the emergency room but weren’t admitted—in their messaging, they could get more workers vaccinated. People often highlight the fact that vaccines prevent serious illness or death, which doesn’t always resonate with firefighters and first responders. 

“They come to work every day with significant inherent risk,” says Dr. Ryan Gerecht, the assistant medical director for FEMS. “What influences folks more in recent weeks is the idea of long-haul symptoms. The idea that ‘My life can change forever. Even if I don’t die, even if my disease is not that severe, I see my friends or I see my family or I see a coworker who can’t get up out of bed in the morning and is too fatigued or has muscle aches that they can’t explain.’”

A video shared on Twitter from one firefighter who got sick from COVID-19 changed minds for this very reason, the department believes. Captain Joe Boling tested positive in early April and spent nearly a week in the hospital with a severe respiratory infection. He’s still recovering and regrets not getting vaccinated. The department has at least 10 members who are considered COVID-19 long haulers. Their symptoms are so severe that many have not returned to full duty. Some continue to rely on supplemental oxygen. 

Some employers of frontline workers have exceeded the federal goal. At Mary’s Center, 74 percent of staff is fully vaccinated and 77 percent have at least received their first dose. The numbers are even better for clinical staff: 100 percent of doctors and 94 percent of nurses are vaccinated. The health center is in the midst of reconciling data to see if anyone got vaccinated outside of work. It’s unclear why coverage is slightly higher because Mary’s Center is using outreach strategies similar to other employers.

Photo by Darrow Montgomery

Leaders continue to consider incentivizing people to get vaccinated by offering them money or other opportunities. Maryland Gov. Larry Hogan, for example, is offering state employees who get the vaccine $100. (A spokesperson for Hogan says “anecdotal responses have been positive,” but wouldn’t elaborate beyond that.) Employers of frontline workers in D.C. question the effectiveness of these tactics.  

“There are some really legitimate and understandable fears within different communities based on historical injustices and stories passed down from friends and family that we can’t ignore,” says Dara Koppelman, chief nursing officer at Mary’s Center. “I don’t know that incentives will get past those things.” 

“What I’m trying to balance is encouraging people to be vaccinated, but also respecting their ability to make a choice,” says McShane of Community of Hope. “If you say, I’ll pay you, but not you, are you punishing someone? I mean, you’re incentivizing, but is there a negative judgment—punishment—of someone else who you don’t know what their experience is. You don’t know why they’re still hesitant.”

Community of Hope might see vaccinations increase when more employees can no longer work remotely, says McShane, which she predicts will happen in the fall. FEMS might see more vaccinations if mask requirements or other restrictions are lifted for fully vaccinated people. “They want to see the benefit. Being safe is not a big enough benefit,” says Donnelly.

There is some polling on incentive-based approaches that offer insight. According to the Kaiser Family Foundation, 39 percent of people who want to “wait and see” would be inclined to get vaccinated if their employer offered them an extra $200. However, slightly larger numbers of this demographic would get vaccinated if their employer offered them paid time off to recover from any side effects, and the vaccine was administered at a place they normally go for health care. 

Some experts are skeptical of incentives, particularly monetary ones. They could backfire by inflaming concerns or appearing coercive. Dr. Evan Benjamin, an associate professor at the Harvard T.H. Chan School of Public Health, says there is a “small role” for incentives, but he does not believe they will move the needle quite like one-on-one conversations with a trusted physician would. Nor has he seen any evidence to suggest that incentives from doughnuts to dollars would. Benjamin studies vaccine hesitancy. As the chief medical officer of Ariadne Labs, he helped create a toolkit that helps health care providers build confidence in the COVID-19 vaccine using what he calls “motivational interviewing” because he thinks this approach will convince more people who are on the fence.   

“The best way to get people to make a decision is really through education,” says Benjamin. “We really have to persuade. And therefore giving people the right information that addresses their specific needs, we have found has been the most effective way.”

Sherri Watkins, director of the Bellevue Family Success Center at Community of Hope, needed to hear a colleague explain the vaccine’s safety and efficiency on four separate occasions to feel good about getting the shot. When she was first offered the vaccine in January, Watkins did not understand how it could be manufactured this quickly when so many other diseases lack remedies. Her colleague helped her understand. Because the nurse practitioner delivered information confidently and consistently, without using any jargon that would make it sound like she was reading from a textbook, Watkins says she felt empowered to get the shot.

Watkins got vaccinated in April. When she called her employer, Watkins says Community of Hope booked her an appointment that same day. Watkins later convinced her husband and son to get vaccinated too. Her family knows COVID-19 is real—it made her son seriously ill. Her personal connection to the virus didn’t factor into her decision-making because Watkins figured she could mask and social distance. Ultimately, she says, she needed to reach a conclusion on her own, not be guilted into one. 

“I don’t want to do it because somebody told me I need to,” Watkins says. “I want to do it because I’m ready to do it. And no matter what happens to me, then I can say, ‘You know what, Sherri, that was your decision and your decision alone.’”