Anti-vaccine rally protesters hold signs outside of Houston Methodist Hospital in Houston, Texas, on June 26, 2021. More than 150 employees either quit or were fired for refusing to be vaccinated.

Mark Felix/AFP /AFP via Getty Images

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Mark Felix/AFP /AFP via Getty Images

Anti-vaccine rally protesters hold signs outside of Houston Methodist Hospital in Houston, Texas, on June 26, 2021. More than 150 employees either quit or were fired for refusing to be vaccinated.

Mark Felix/AFP /AFP via Getty Images

When Pam Goble first heard that President Biden was mandating the COVID-19 vaccine for health care workers, she had one thought: It’s about time.

Goble is owner and CEO of Ability HomeCare, a pediatric home health care agency serving 900 children in San Antonio, Texas.

Of her 261 nurses and therapists, 56 have declined to get the vaccine.

“I am one of those people that really feels everybody should have their choice,” says Goble. She did not impose her own vaccine mandate even as the delta variant drove a spike in Covid cases among her employees and the families they serve.

Now she’s concerned that her unvaccinated employees may refuse to comply with the federal mandate once it’s implemented later this fall.

“We would have to let people go,” she says. “I worry if our patients, who are medically fragile children, are going to get the care they need.”

Biden’s mandate covers 17 million health care workers

Health care workers had priority access to the COVID-19 vaccine back in December 2020, but nine months later, many are still reluctant to get the shots. Vaccination rates remain low in some states and among some subgroups of health care workers such as nursing assistants. As part of his push to get more Americans vaccinated, Biden has essentially told 17 million health care workers: Get vaccinated or get out. He has not offered them the testing option he’s given workers in most other industries.

Details about how the federal vaccine mandate will be enforced have yet to be released, but already protests have become regular events outside hospitals, and employers are warning they could see large numbers of workers quit just when they’re needed the most.

It’s hard to predict how many people will actually quit their jobs over the vaccine mandate. In June, after a federal judge dismissed a lawsuit brought by health care workers at Houston Methodist Hospital over its vaccine mandate, more than 150 workers quit or were fired.

Lewis County General Hospital in upstate New York said it would stop delivering babies this month after six people in the maternity department quit over New York’s vaccine mandate.

In Maine, where the governor announced a vaccine mandate for health care workers in mid-August, hospitals are so far only reporting only a handful of resignations, but enforcement of the mandate is still more than a month away.

Losing even one or two workers would be a problem

“I can’t afford to lose anyone,” says Ted LeNeave, CEO of Accura HealthCare, which operates 34 nursing homes and assisted living facilities in Iowa, Minnesota, Nebraska and South Dakota. Because of staffing shortages, they’ve had to limit admissions, turning down patients coming from hospitals.

With about 1,000 of his employees — 38% of his workforce — unvaccinated, LeNeave is calling on the federal government to provide a testing option for health care workers. He’s proposed that those who remain unvaccinated would undergo regular testing and wear full PPE, arguing that it’s a safer alternative to losing a lot of workers.

“I just don’t see how I can lay off a thousand people,” says LeNeave. “I’d have no one to take care of the patients, and there’s nowhere to send the patients.”

LeNeave has offered his employees incentives to get vaccinated, including the chance to win $1,000 in a lottery, but he says many remain fearful. Some cite false claims about the vaccines’ effect on fertility while others want to wait a year or two to see if any problems arise. And then there are those who are against it, period.

Health care workers may opt to change professions

He expects many will change professions to avoid getting the shots. Certified nursing assistants, who bathe, feed and groom nursing home residents, are among the lowest paid workers in the U.S. There are plenty of other options for those who want out.

“Especially with our facilities in rural areas, we could lose nurses to go work at Casey’s or Kum & Go,” gas station convenient stores. In those jobs, workers would have an option to get tested rather than be vaccinated.

In Texas, Goble is baffled that this far into the pandemic, and with more than a thousand people dying from Covid every day, the vaccines remain so politicized.

“I keep hearing this anti-vaccine argument about freedom,” she says. “But I want my freedom to live out from under a pandemic. And I want the children and families we serve to have that right too.”