Large pockets of first responders, front-line health workers, and other public-facing employees are so far refusing COVID-19 vaccination by the thousands in Massachusetts, prompting calls for state government and private employers to make getting shots a condition of hiring.
Already, the president of one of the largest senior care operators in the state, Hebrew SeniorLife, has said its facilities plan to require COVID vaccines for new employees later this spring when shots are more widely available. And Attorney General Maura Healey earlier this week suggested that public safety employees, such as State Police and prison workers, should be expected to get the shots.
”[If] you’re going to sign up for public work, and receive a paycheck from the taxpayers of this state who have sacrificed and lost so much . . . [and] you can’t get a vaccination? It’s irresponsible,” Healey said on GBH’s Boston Public Radio, while acknowledging that some may have health conditions that prevent them from getting the shots.
Though public attention has focused on the stampede of people trying to schedule vaccine appointments, there are also significant numbers of vaccine holdouts, including people whose jobs bring them into close contact with the public and potentially the virus.
The Globe reported last week that 30 percent of the State Police’s 2,850 employees haven’t been vaccinated at department-run clinics, though department officials said they know that some booked appointments elsewhere. And more than half of Department of Correction employees have refused the state’s offer to get the COVID-19 vaccine at work.
Now, a Globe survey of nearly two dozen of the state’s largest police, fire, and emergency medical departments shows swaths of others declining to get the shots through their employers. Roughly 54 percent of Boston police employees booked vaccinations through the department, though its medical staff estimates another 20 percent sought doses at other clinics, based on an informal department survey.
At that rate, about 750 — one of every four of its 2,890 employees — would be unvaccinated. Just 63 percent of the city’s 1,460 firefighters are vaccinated, as are 73 percent of Boston EMS workers, according to data provided by each agency.
Vaccination rates varied widely at other public safety agencies, with some, such as the Cambridge police and fire departments, reporting more than 80 percent or close to 90 percent of employees vaccinated. But at the Springfield fire and New Bedford and Fall River police departments, officials said 50 percent of employees or fewer have gotten vaccines through their departments — which organized appointments for them starting in January — though the numbers don’t account for those who received doses at other clinics.
Some public safety officials said they understood why employees may be reluctant to get vaccinated.
“Making the decision whether you’re going to take the vaccine is a very personal decision,” said Boston police Detective Jeffrey Lopes, president of the Massachusetts Association of Minority Law Enforcement Officers. “It’s something you’re allowing a medical professional to insert into your body. It’s something that you have to be OK with.”
Lopes, who has received a vaccine, said a mandate may be well-intentioned, “but I don’t know if it’s doable.”
At hospitals and nursing homes, the majority of staffers have been vaccinated, according to state data, but injection rates dip to as low as 60 percent at some facilities where immigrant workers, distrustful of government and the health system, have held back.
Lou Woolf, president of Hebrew SeniorLife, said the numbers are worrisome enough that his facilities make it clear to new employees that they are expected to get vaccinated. It’s voluntary now, but Woolf expects to make vaccination a requirement soon.
“It is the right thing to do,” he said. “We need to be doing everything we can . . . to protect our residents, our families, and our staffs.”
The reasons people choose not to be vaccinated can run the gamut from distrust of its safety or the government, to a desire not to rush to be among the first to receive it. Some may also have medical conditions or religious beliefs that prevent them from being inoculated.
Governor Charlie Baker, in an interview last week, said he wouldn’t rule out a state vaccination mandate at a later time. But he expressed little enthusiasm for it, saying he would prefer to “nudge” reluctant residents to get shots. He also said a mandate would require a new law.
“And several people on my team have questioned the constitutionality of it,” Baker said, later adding: “I think the biggest opportunity here is to get people to do it because they want to to protect themselves and their friends and their families. And I think that strategy, in the end, will bear fruit based on everything we see.”
Baker said vaccine-averse residents, especially people of color who’ve faced historic health care discrimination, “have legitimate reasons” for being wary. “And I’d much rather try to nudge them into it at some point because their church leader or their doc or their neighbor or their sister or their brother gets vaccinated” than have the state try to force them.
More than 1.1 million Massachusetts residents are fully vaccinated, and another 900,000 have received first doses in two-shot vaccine regimens, state data show. The state’s goal is to immunize about 4.1 million residents by July 4.
Healey said she thinks public-facing employees at the State Police and prison workers should be required to get shots. But she noted that she wasn’t giving a legal opinion. ”I’m answering this question as a matter of what’s right and practical and common sense,” she said in the GBH interview.
Gerard Mahoney, Cambridge’s acting fire chief, said he agrees that those in public safety should be vaccinated, though he questioned whether collective bargaining could hinder any mandate.
“I can’t understand why someone working in public safety wouldn’t take advantage of the vaccine,” said Mahoney, whose department’s vaccination rate of 87 percent was the highest of 23 agencies surveyed by the Globe.
Woolf at Hebrew SeniorLife would like the Baker administration to institute a state mandate covering all long-term-care workers. Otherwise, he fears nursing homes, rehab hospitals, affordable housing, and retirement communities that impose mandates on their own could lose employees to other facilities.
The possibility of a mandate has been raised with state Department of Public Health officials during meetings of a vaccine advisory committee, but officials haven’t committed to it.
One obstacle some have cited is that unlike flu shots, which have been required in the past, COVID-19 vaccines have yet to win full approval from the Food and Drug Administration. The drug agency cleared the vaccines only for emergency use until it reviews more data. Once that happens, possibly in the coming weeks, the push for a state mandate could intensify.
Nationally, while small numbers of physician practices and other employers have issued vaccination mandates, most are encouraging employees to get shots voluntarily, at least for now, said Michelle Strowhiro, a Los Angeles-based partner in the employment law practice at McDermott Will & Emery, who heads the firm’s COVID-19 task force.
Strowhiro said federal law doesn’t prevent employers from imposing mandates if a vaccine is available through FDA emergency use authorization. But she said federal antidiscrimination law requires employers to make exceptions to mandates for workers with certain health conditions, disabilities, or religious beliefs. That could require human resources and legal staff to deal with compliance.
Another factor is that dozens of states, though not Massachusetts, are considering legislation that would prohibit employers from requiring workers to be vaccinated.
And Strowhiro said an employer could face a difficult challenge trying to enforce a vaccine mandate.
“The reality may be that a significant portion of a workforce doesn’t want the vaccine. Are they really going to lay off 40 percent of employees if they won’t get it?” she said.
A century-old US Supreme Court case, known as Jacobson v. Massachusetts, offers some precedent for a state vaccine mandate. In 1905, the court ruled that it was within the power of a state “to enact a compulsory vaccination law,” and that individual liberties could be restricted to protect the overall public health.
Courts today would likely apply a higher legal bar to any vaccination mandates, requiring that a state government have a compelling interest to impose one, said Kent Greenfield, a Boston College law professor. But, he said, achieving herd immunity against a pandemic that’s upended life worldwide is likely compelling enough.
“I think the state could meet that,” Greenfield said.
Baker has said he would like to see federal guidance on the issue of mandates. But so far, the Biden administration has taken an encourage-but-don’t-mandate posture.
Anissa Gardizy of the Globe staff contributed to this report.