Vaccine doses are prepared in syringes and packaged in zippered plastic bags.

COVID-19 vaccine preparation at a drive-thru vaccination clinic at Portland International Airport, April 9, 2021. The clinic is a joint operation hosted by Oregon Health & Science University, the Port of Portland and the American Red Cross.

Kristyna Wentz-Graff/ OPB

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The deadline for many Oregon workers to get vaccinated was Oct. 18. At the Department of Corrections, roughly 67% of employees got vaccinated. Another 20% got a religious exemption. At Portland Public Schools, over 90% of employees got vaccinated and 37 staff members were recommended for termination. Patrick Allen, director of the Oregon Health Authority, tells us about the effects of the mandate, and what vaccination rates look like around the state.

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Note: The following transcript was computer generated and edited by a volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Monday was the deadline for many Oregon workers to get vaccinated against COVID-19 but the results of that mandate have varied widely. At the Oregon Department of Corrections, roughly 67% of employees got vaccinated, about 20% were granted exemptions, most of them religious. At Portland Public Schools, 90% of employees got vaccinated and 80 staff members were let go. Patrick Allen is the Director of the Oregon Health Authority. He joins us now for a statewide look at the effects of this vaccine mandate and what might come next in the public health effort against COVID-19. Pat Allen, welcome back to Think Out Loud.

Patrick Allen: Glad to be back.

Miller: Did the state have a goal or a target when it enacted this mandate in terms of what percentage of adults in Oregon would be vaccinated by October 18? the overall effect of the mandate?

Allen: Actually, the overall target was to increase vaccinations. I think the thing that’s important to remember is that this is particularly true for the State. Our employees are all over the state, and are really a product of the communities that they live in. So a 90% vaccination target might make sense in the Portland area and that’s what a lot of... as you observe Portland Public Schools... a lot of hospital systems, our own OHA employees in the area got to. But corrections has facilities in very remote and rural parts of the state. Other agencies are scattered all over. And so really, the point of this was to get that rate higher than it otherwise would have been. And I think it’s unquestionably been a success from that standpoint.

Miller: Are you able to point to data to show that? One of the challenges that we seemed to encounter a couple days ago, and we talked about this, was that employers said,

‘well, we weren’t really asking people until the mandate kicked in about their status’. So they said it seemed anecdotal. That’s what we heard, for example, from a spokesperson from Hillsboro Schools. Can you say, ‘...this is the way in which the mandate increased vaccination rates?’

Allen: Sure. I think some of it’s anecdotal, and I think some of it is hard data. The hospital systems were a little bit ahead of the curve from a time standpoint. And the pretty consistent reports that I have seen from hospital systems was something on the order of about a 10% point increase in their vaccination rates from the point that they first started. It let people know that there was going to be a requirement and a deadline. I think from a state employee standpoint, even the rate at corrections, if you look at where their facilities are, that 65% is significantly higher than the background rate in places like Umatilla County, Malheur County, Lake County, the kinds of places where they have large numbers of employees.

Miller: I should say that we’ve spent a lot of this week talking about this one vaccine mandate deadline, but more mandates are still to come, including the federal one regulated through OSHA, for larger private sector employees. Plus some workers under Oregon’s Executive Branch have until the end of November now to get fully vaccinated. So there’s more to come in terms of mandates. But sticking with the news of this week, do you have an estimate in terms of the percentage of health workers in the state who left their jobs because of the mandate?

Allen: It appears to be very small, and we don’t have a comprehensive data collection on that. But the reports that we’ve gotten from the large health systems is that it appears to have been significantly less than 5%.

Miller: How would you respond to the health workers who have protested about this over the last month saying that this should be a matter of personal choice and that some of whom took their protests so far as to resign or to be fired?

Allen: Well, certainly getting vaccinated is a choice, I completely agree with that. And people have got a choice of if they want to stay with the employer that has a vaccination requirement to get vaccinated or make a different career choice. But I think one of the things that’s been challenging about both vaccines and masks is they don’t work very well as an individual decision that you’re going to do it to protect yourself. They’re both designed as community tools. They work best when the entire community buys into ‘we’re all going to get vaccinated,’ whether it’s COVID or measles or polio, or anything like that. And the same thing with masks. They work better when you’re wearing a mask and I’m wearing a mask, rather than if I’m wearing it hoping that that will somehow just protect me.

Miller: You noted that overall, statewide, it doesn’t seem like a large percentage of healthcare workers have lost their jobs or resigned because of this mandate. But the fact is that some people have lost their jobs. We’ve looked at health systems in Bend, in the Rogue Valley, who have talked about this. And this is on top of a time when a lot of hospitals and nursing homes have already been short staffed. Is there a statewide plan for building back these workforces or is it really just up to local facilities?

Allen: Well, what we have at the statewide level right now is the ability to respond to staffing shortages should they occur and be able to fill those gaps and make sure that care can be provided. Longer term, the legislature approved all sorts of investments in the health care workforce to try to build it because health care isn’t that different than any other workforce out there, where there simply are shortages. But the piece that’s also really important to remember is the other thing that happens from increased vaccination is less quarantine and isolation because people who are vaccinated don’t need to quarantine if they’re exposed, and fewer people out sick because they’ve gotten COVID. That’s especially true in places that had low vaccination rates and the health care workforce was able to get that vaccination rate up to a much more meaningful level. So there are both benefits and challenges around the vaccine requirement. But I think on balance the benefits outweigh.

Miller: I want to turn to medical or religious exemptions. And overall religious exemptions have been by far the higher percentage of ways that people were able to stay in their jobs in Oregon without getting vaccinated. The sense I got on Monday talking to the city manager in Vale was that religious exemptions have proved to be a way to keep their emergency response intact. 50% of Vale fire and ambulance staff got religious exemptions. Is that what the state intended when it said, ‘this is an out if you apply for it?’

Allen: Well, what the state intended was to comply with federal civil rights law that requires, in most cases, that you provide an exception for genuinely held religious beliefs. So we provided a vehicle for that to occur. I can’t comment on Vale in particular without knowing the specifics of those exemptions, but a sincerely held religious belief is the kind of thing that’s hard to… there’s not a test for that or something that you can look at and determine, ‘is this really sincerely held?’ So you are dependent on someone who’s claiming that exemption doing that in good faith.

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Miller: The Oregonian, though, did report this morning that executive branch employers in Oregon granted exemptions at twice the rate of their counterparts in Washington State. How do you explain that?

Allen: You know, I can’t comment on how Washington State might have looked at compliance with federal civil rights law versus what we did in Oregon. There are circumstances where your ability to deny those exceptions varies, depending on the nature of the employer, the nature of the work. I just don’t know enough about how Washington approached this to really be able to say.

Miller: Then let’s focus back in Oregon and one of the executive branch agencies, the Department of Corrections, which I mentioned earlier has about a 20% exemption rate, the vast majority getting religious exemptions. What’s the point of a mandate if one out of every five workers can seemingly pretty easily get out of it?

Allen: Well, I think you can look at the one out of five workers who got out of it presumably because of their sincerely held religious beliefs. But you can also look at the increase in the rate of vaccinations, and my understanding of the numbers from when we first started tracking at the beginning is that the rate of vaccination at Department of Corrections went up significantly, and I think that’s the important thing to focus on.

Miller: So I’ve had a couple questions about the rate or the number of exemptions. But there is another piece of this story, which is what the workers can or can’t do after they have gotten that exemption. Your agency outlined a whole series of potential added safety measures that healthcare employers can put in place for their unvaccinated employees who’ve gotten these exemptions. They include modified shifts, periodic tests for COVID-19, the opportunity to do tele-work or reassignment. What happens if employers don’t do any of this?

Allen: We’re able to respond to complaints if they impact workers safety. Then individuals can potentially file a complaint with Oregon OSHA to respond to that. We’ll look into circumstances and see if there’s a lack of understanding of what should be done, an intent to simply not comply with the with the law, any number of things based on what the circumstances are.

Miller: So to take one example again, on Monday when we had a kind of tour of the state to talk about these issues, we talked to the CEO of the Lake Health District. They run a hospital, various specialty clinics, long term care facility. The CEO told us that vaccinated and unvaccinated employees would not be treated differently at all. That does seem to go against state guidelines. But are you saying that it would be up to somebody in Lake County to complain for the state to come in and say you should actually treat these employees differently?

Allen: Well, first, I’m not sure that you necessarily automatically would assume that they have to be treated differently. I don’t know what the standards of personal protective equipment usage, for instance, are there or how their cohorting staff, or any of those kinds of things. So there are certainly a number of ways that you could ostensibly be treating people the same. But taking adequate steps to protect people from those who aren’t vaccinated but beyond that, then yeah, if someone is concerned that they’re not complying with the law, they can contact us and we would respond to that.

Miller: Why not treat the unvaccinated health care workers the way Washington state did, where they said this isn’t going to be a voluntary thing where you can get an exemption and then continue to work as long as you’re wearing a mask. There, if I understand correctly, they basically said, we can’t make accommodations, we can give you an exemption, but if you have certain kinds of key, frontline healthcare jobs, you simply can’t do this job if you’re not vaccinated. You can get an exemption, but you can’t get an accommodation. Why not take that approach in Oregon?

Allen: That is available to employers in Oregon.

Miller: But why not mandate that, instead of saying it’s available to them?

Allen: Well, because every organization’s circumstances are going to be quite different. One organization may easily be able to provide remote work for somebody 100% of the time and another may not. So we really want to provide a portfolio of tools and let individual employers use the portfolio of tools in a way to try to maintain its operations and make legitimate accommodations to folks.

Miller: What’s on the horizon now at the state level in terms of the next steps in combating the spread of COVID-19?

Allen: Well, I think the next big event is going to be the presumed approval of vaccines for kids aged 5 to 11, which is being taken up later this month and early next month by the Food and Drug Administration and CDC. That’s our largest pool of unvaccinated Oregonians. It is the pool that, although we’re approaching 80% of adults vaccinated right now, that pool of kids will help get the overall population up to a much higher vaccination level. I’m not sure we’re still thinking in terms of herd immunity, but we’re certainly thinking in terms of a rate of vaccination that breaks the linkage between cases and hospitalizations. We haven’t quite gotten there yet. On both fronts we’re much lower than we were during the summer peak. But we’re about where we were last winter at the peak. And so we still need to increase that rate of vaccination to get those numbers down to be able to think about ‘what’s the next phase of the pandemic look like.

Miller: When you say you’re not sure that we’re thinking about herd immunity at this point, what do you mean?

Allen: The estimates of the vaccination rate or vaccination and exposure rate needed to get to herd immunity, as infectious as the delta variant is, keep going higher and higher. There is a body of thought out there in the literature that is beginning to say this may be like other coronaviruses, or like influenza, where you don’t really get herd immunity. What you use is a portfolio of tools, including treatments and vaccines and other precautions, to live with the virus endemically.

Miller: Last week, Washington Governor Jay Inslee announced a statewide requirement that attendees at larger events have to show proof of being vaccinated against COVID-19 or proof of a negative COVID-19 test within the last three days in order to take part in those events. Should Oregon do something similar?

Allen: As we move beyond the crisis phase of this and into ‘how to live with the virus’ (again, endemically, if that’s the direction we end up going), that’s certainly something that might be one of those tools in the toolbox. But it’s not something that’s being considered right now.

Miller: And something like a statewide vaccine requirement for more indoor spaces - not not just big events but, say, restaurants and bars - something we’ve seen at the city level in various cities around the country. Is that being talked about at the state level?

Allen: It’s not something that’s an immediate proposal, but I would expect us to be presenting to the Governor soon. It’s certainly one of the tools that could be considered moving forward.

Miller: Patrick Allen, thanks for your time once again. I appreciate it.

Allen: Glad to be here.

Miller: Patrick Allen is the Director of the Oregon Health Authority.


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