During the grim, early days of the pandemic, Anne Smail was among the nurses at Brigham and Women’s Hospital deployed to a COVID intensive care unit. She saw what the virus, at its worst, could do.
But when her employer mandated COVID vaccinations for employees, Smail, 57, requested a religious exemption. “I’m Christian,” she said, “and I’ve always believed I have a choice to put in my body what I want.”
Her request was denied, and after two decades at the Brigham, Smail is getting fired and searching for a new job. “I’m not having something pushed on me,” she said.
Most hospitals across Massachusetts have mandated vaccination for their workers, noting their unique role in treating sick and vulnerable patients, including those who cannot be vaccinated or have weakened immune systems.
The vast majority of hospital workers in the state — 98 or 99 percent at several hospitals — have complied. At Mass General Brigham, the state’s largest health care provider and largest private employer, 99.4 percent of employees had been vaccinated by Friday, the deadline to get a shot and keep their jobs.
But a tiny minority of front-line workers in Massachusetts have refused the COVID vaccines, and for that decision, they’re losing their jobs.
Like others in society who eschew the vaccines, they offer various reasons. Many say vaccination goes against their personal religious beliefs. Some say the vaccines are unnecessary, or question the data showing the vaccines work. Some are worried about side effects. Others just don’t want to be told what to do.
Smail remains unconcerned about catching COVID or spreading it because she’s in good health and takes care of herself. “If I have a sore throat, I stay home,” she said.
She is among 458 people whom Mass General Brigham expects to terminate for their refusal to take the COVID vaccines, despite months of prodding and a final opportunity to rethink their decision during an unpaid suspension. They include nurses and administrative workers, managers and the rank and file, spread across different hospitals and clinics.
Rosemary Sheehan, chief human resources officer at Mass General Brigham, said she’s pleased that so many of the organization’s more than 80,000 employees chose to comply.
“We’re as good as we’re ever going to get,” she said. “Additional time would not have made a difference at this point. The people who have not been vaccinated are really people who do not want to be. There’s very little we can do.”
Mass General Brigham and other hospital systems approved only some of the requests they received from employees who wanted exemptions from the mandate, either for medical reasons or for sincerely held religious beliefs.
“We’re not a supermarket, we’re not Amazon, we’re not a consulting company,” Sheehan said. “We are a place where sick people come to be healed and where sick people expect a safe environment. That’s an important lens that drove our view of all exemptions.”
Boston Medical Center fired 104 employees who declined the vaccine, and Wellforce, the hospital network that includes Tufts Medical Center, also terminated 107 people. Baystate Health previously said it fired 90 people, including 52 per diem workers, who remained unvaccinated.
At Beth Israel Lahey Health, 153 employees are on leave and will lose their jobs if they don’t get vaccinated by the middle of the month.
Many hospitals also require their workers to get annual flu shots, and nearly all workers tend to comply.
But some health care workers are suing their employers over COVID vaccine mandates — including a group of people losing their jobs at Mass General Brigham. Courts generally have upheld vaccination mandates.
Several hospital employees who refused vaccines spoke with the Globe but did not want to be identified by name because of concerns they would be bullied or otherwise mistreated for their decisions.
Nicole, a nurse at the Brigham who declined to use her last name, said she felt hopeless and lost when the pandemic began in 2020, until a friend encouraged her to find Jesus. She started listening to Bible podcasts and Zoom sermons.
“It was calming, listening to scripture,” she said. “It really made me feel OK with the state of affairs.”
Nicole said she declined the vaccine to keep her body “pure,” in line with her faith. She also stopped drinking alcohol and eating meat. She said frequent handwashing and the use of personal protective equipment are enough to keep herself and those near her safe from COVID.
“I’ve never been singled out because of what I believe. It hurts,” she said. After spending some extra time with her young children, Nicole, 40, said she will look for a new job, most likely in another state.
A 50-year-old nurse from Boston Medical Center said she, too, did some “soul searching” and joined a church during the pandemic. She decided she didn’t want to put “foreign” substances, including vaccines, in her body. After her request for a religious exemption was denied, she lost her job in October.
“Do I want to keep my patients safe? Of course I do,” said the nurse, who declined to be named. “We have PPE. We have N95s. We wash our hands.”
Nurses, whether vaccinated or not, must wear protective equipment when they’re with patients, she noted: “Your PPE is what’s keeping you safe.”
The health care workers being fired for refusing the COVID vaccines will have limited options if they want to find new jobs in the medical field. Federal health officials on Thursday issued a new rule applying to more than 17 million workers at hospitals, nursing homes, and other health care facilities that receive Medicare and Medicaid funding.
The regulation requires workers to get at least one shot of COVID vaccine by Dec. 5 and be fully vaccinated by Jan. 4, though it doesn’t apply to people who work remotely, away from patients.
Employers must allow their workers to request exemptions for medical or religious reasons, but they have some flexibility in determining which and how many exemptions to grant, said Anthony Cichello, a health care and employment lawyer and partner at Krokidas & Bluestein in Boston.
“Every nurse or doctor or [nursing assistant] or maintenance person that they lose is a huge loss, because they’re struggling to get employees and staff their operations,” Cichello said. “They don’t terminate people lightly. We’ve seen [hospitals] try to extend deadlines and go out of their way to educate people about the benefits of the vaccine and really try to give people a second, third, fourth chance before they ultimately have to terminate people.”