Institution-related vaccination requirement: “Not to be lifted by staff”

With the facility-related vaccination requirement, many nursing staff are threatened with consequences – but only in theory. It is questionable whether the health authorities will really take action.

At Haus Landgraf, a nursing home in Worms in Rhineland-Palatinate, almost all employees have been vaccinated against Covid-19. Only one employee in the nursing department could not be convinced – for fear of side effects, reports home director Benedikt Queins. The head of the facility must now report the unvaccinated nurse to the responsible health department. What happens afterwards? Ques doesn’t know.

“As long as the health department doesn’t prohibit us, we’ll continue as before,” he says. He doesn’t want to do without her: “The employee is an important support and will continue to be on the roster.” In any case, there is a shortage of staff in nursing, every helping hand is needed.

How many in healthcare are affected?

The unvaccinated employee at Haus Landgraf is not an isolated case: according to a SWRsurvey, in February there were still tens of thousands of employees in German care facilities without full vaccination protection. According to this, several federal states have a vaccination rate among nursing staff that is between 84 and 92 percent.

The vaccination rate in hospitals is probably slightly higher. Nevertheless, the burdens threatened by the loss of staff are noticeable, says Peter Förster, Managing Director of Westpfalz-Klinikum GmbH. According to Förster, the vaccination rate across all locations is 95 percent, but over 150 employees could still be absent.

“It hurts – of course. It will bring us to a point where we no longer have the amount of staff available for care and may have to reduce beds again,” says Förster.

How is partial vaccination implemented?

The responsible health authorities in the cities and districts must enforce the institution-related vaccination requirement. The process for this is clearly regulated: In a first step, the homes, hospitals and practices report the employees who cannot show proof of vaccination, proof of recovery or a medical certificate to the respective health department.

The office then contacts these employees and asks them to submit proof. The plausibility of the certificates presented, for example due to vaccination intolerance, is also checked. If there are doubts about the authenticity or if proof of vaccination is still not provided, the health authorities should impose a fine – up to 2500 euros are possible. Ultimately, the office should impose a ban on entry for the unvaccinated staff – that’s the theory.

Overburdened health authorities should enforce compulsory vaccination

In practice, however, the health authorities are chronically understaffed and have worked at the breaking point for two years due to the pandemic. For many, the implementation of compulsory vaccination is an additional, almost insurmountable, mammoth task. “We have to check each individual case,” says Anja Brilmayer, a doctor at the health department in Bad Kreuznach.

The personnel situation in the respective facility should also be taken into account, i.e. whether the affected employee can be dispensed with at all and with which people the unvaccinated employee meets in the facility. “With the effort that we have to put in, it’s not possible to manage it in terms of personnel,” says Brilmayer.

“Bureaucratic effort is enormous”

“The bureaucratic effort is enormous,” warns Gerald Gass from the German Hospital Society. The administrative effort in advance, for example to record the vaccination status of the staff, was very large.

This is now being repeated by the health authorities: “We will now see that from today on, the health authorities will be given hundreds of thousands of names, which then have to be investigated on a case-by-case basis. That is indeed hardly affordable.” He fears it could take months to complete the reviews.

But just a threat?

So will it be possible to enforce compulsory vaccination at all? “I don’t assume that we will issue an entry ban here in the Bad Kreuznach district,” says District Administrator Bettina Dickes. She expects that many people who have not been vaccinated will submit a courtesy certificate – that is, a certificate even though there is no actual intolerance. It is very difficult for the employees of the health department to take action against this. “After all, we can’t bring in medical records and just take a look,” says Dickes.

The investigation of these cases will take a long time and often end up in court. In many individual decisions, the facility-related vaccination requirement will then be overturned.

Little more would then remain of the compulsory vaccination than a threatening backdrop built up over many months. Nursing home manager Benedikt Queins is also skeptical as to whether there will be a significant number of entry bans. “You will make many appeals to our industry, but you will hardly be able to do more.” He sees the health authorities in a dilemma: “In the care facilities where few unvaccinated people work, you will be able to tolerate them. In the facilities where many unvaccinated people work, you will have to accept them, because withdrawing these employees would then endanger the security of supply. “