Who has COVID-19 vaccination requirements?

When the Saint Alphonsus Health System announced on July 8 that it would require COVID-19 vaccinations from its many employees, the St. Luke’s Health System, Idaho’s largest, and the 20-clinic Primary Health multipractice followed suit within hours.

The announcements of these three health care providers on the same day were apparently coincidental. These providers denied coordination with one another when the Idaho Business Review inquired. In the case of Saint Alphonsus, its announcement was prompted by its parent, Trinity Health. The fine print on Saint Alphonsus’ statement on the vaccination requirement excluded its operations in Oregon, which has a 1989 law on the books making it illegal for employers to require vaccination specifically of health care workers.

Saint Alphonsus was not acting in isolation but in concert with hundreds of other Catholic-affiliated hospitals across the country. Because this is a trend much bigger than Idaho’s tiny number of 47 hospitals across the state, what follows is a look at who is requiring employee COVID-19 vaccinations.

One-third of all Catholic health care requires COVID-19 vaccines

Catholic-affiliated health care makes up approximately 15% of all traditional community hospitals in the United States and is the largest block of nonprofit care nationally. Even in Idaho, over a tenth of the state’s hospitals started as Catholic institutions following that church’s historic mission to charitably heal the sick, including Saint Alphonsus (Boise/Nampa/Ontario/Baker City), St. Mary’s (Cottonwood), Saint Joseph’s (Lewiston) and Franciscan-founded Lost Rivers Medical Center (Arco), which is now an independent taxing-district.

Out of those, Saint Alphonsus, with its four hospitals and many clinics, is ranked by the IBM Watson rankings as one of the 15 best health systems in the nation. The IBM Watson health care awards are considered by some to be the Pulitzer Prize of the hospital world. It’s a very big deal.

Saint Alphonsus did not capriciously act alone in its vaccination requirement. Saint Alphonsus is part of the Catholic Trinity Health System, a network of 91 hospitals spread across 22 states, which employs over 117,000 people. According to the authoritative Becker’s Hospital Review, which ranks health systems by the number of hospitals they run, Trinity is the fifth-largest health network in the country, and the third-largest Catholic-affiliated system after Ascension (151 hospitals) and Common Spirit Health (142 hospitals).

The day before Trinity made its announcement, the Catholic-affiliated Mercy system (41 hospitals in the Midwest) issued a requirement on July 7 for all its employees to be vaccinated for COVID-19. Mercy is the 16th largest health system nationally, and shares a slot with Saint Alphonsus and Idaho’s Episcopal-founded St. Luke’s as one of the 15-top health systems in the country in the IBM Watson rankings.

The day after the Trinity announcement, on July 9, the independent but Trinity-affiliated MercyOne network in Iowa (19th largest, 39 hospitals) also put mandatory vaccination in place for its employees. Given the relationship with Trinity, MercyOne’s move was likely not coincidental. Add to these the Catholic SSM Health System, which includes the large teaching hospital of St. Louis University. This system is the 36th largest in the nation with 23 hospitals. It announced mandatory COVID-19 vaccination for employees on June 28, a week before the trio of Trinity, Mercy and MercyOne.

Much bigger than just Catholic health

It is not just a large slice of the juggernaut Catholic health system that is moving toward vaccination requirements. For example, the City of San Francisco has passed a local law requiring vaccination of all health care providers who work within city limits, the first government entity in the country to do so. University hospitals with employee vaccination requirements for COVID-19 now include all five in the University of California systems, Ivy League medical schools and affiliated health systems of Cornell, Columbia and University of Pennsylvania, Indiana University Health and Newark Medical University Hospital.

In an interesting move, the member hospitals of the Connecticut Hospital Association, the Maryland Hospital Association and the District of Columbia Hospital Association all voted in June to require COVID-19 vaccinations of their employees. These three associations represent 84 hospitals, which include all the community hospitals in two states and one U.S. territory. On June 15, the 15-hospital BJC Health System of Missouri moved to require employee vaccinations for COVID-19. While it’s a relatively small system, BJC includes the famous Barnes Hospital in Saint Louis, which is the 6th largest hospital in the country. Other famous hospitals with COVID-19 vaccination requirements include Yale-New Haven (4th largest), John Hopkins (10th largest) and Mass General (15th largest).

It’s a veritable who’s who of medical establishments. The best and brightest in medical establishments are moving toward mandatory COVID-19 vaccination requirements for employees. Governments around the world are doing the same. The nation of Vatican City required employee vaccinations in February. France just required on July 14 all health care workers to get vaccinated. Italy did so in March. Jakarta, capital of Indonesia, required everyone who lives there to be vaccinated back in February. Turkmenistan required all adult residents to be vaccinated on July 7. Saudi Arabia required all private and public employees to be vaccinated in May. Greece, Australia, Russia, and the United Kingdom have all passed similar requirements for different slices of health care and other essential employees.

Becker’s Hospital Review is currently maintaining a frequently-updated list of health systems and hospitals in the United States who have required COVID-19 vaccination for employees.

Those without a mandate

Some of the nation’s largest health care  systems have not made a move to require COVID-19 vaccinations of employees. These include the nation’s largest, HCA Healthcare with its 185 hospitals, including West Valley Medical Center in Caldwell and Eastern Idaho Regional Medical Center. Other no-requirement systems include the two largest Catholic hospital organizations, Ascension and Common Spirit Health.

Included in their ranks is the Kaiser Permanente system, which told HealthCareDive that: “Vaccination will only be required for Kaiser Permanente employees if a state or county where we operate mandates the vaccine for health care workers.” Other notable systems include Utah-based Intermountain Health, which owns the Saltzer multipractice in the Treasure Valley, as well as Intermountain’s former failed 2020 merger partner, South Dakota-based Sanford Health. Sanford is notable for firing its CEO for refusing to wear a mask after recovering from COVID-19.

Some pundit voices like the Pew Charitable Trusts, the San Francisco Chronicle and HealthCareDive have opined that it’s only a matter of time before all United States hospitals and many other employers do the same. Many hospitals, including those in Idaho, already require other vaccinations. One Idaho example is Kootenai Health, which requires a flu shot every year of its employees. Kootenai owns its anchor regional medical center in Coeur d’Alene, as well as the Benedictine-founded St. Mary’s in Cottonwood and Kiwanis-founded Clearwater Valley Hospital in Orofino.