How to Vaccinate Health Care Workers: Unions

This is a month old now but as relevant as ever:

Understaffed, underpaid, and under-protected long before COVID-19 struck, health care workers in the US have had a brutal and traumatic year. Our caregiving workforce – overwhelmingly made up of women, people of color, and immigrants – was on the receiving end of a cascade of political and economic failures set off by the outbreak, but already endemic to life in the United States.

Gloria Duquette is a CNA who works in two nursing homes in Hartford, CT and has a third job providing home care. She is also a delegate in SEIU District 1199 New England, a union of nearly 30,000 health care workers in Connecticut and Rhode Island (and, full disclosure, an old employer of mine). When her co-workers at one job began noticing COVID symptoms among residents last spring, the facility’s administrator denied it, telling them they did not have the knowledge or expertise to make a diagnosis. Supervisors walked around in N95 masks, but told workers there was no COVID in the building – and no PPE for them.

Dozens of residents died, and countless employees fell ill, including Duquette, whose husband then also got sick. At her other job, a former CNA who had just finished nursing school also brought COVID-19 home from work. It left her physically disabled and emotionally wrecked: the virus killed her 72-year-old mother. Her boss never contacted her, Duquette said, and “she had to do a GoFundMe to bury her mom. Her life has been destroyed and the bosses don’t care about her or her family.”

“So when we say ‘Black Lives Matter,’ it’s not just about police kneeling on the necks of our brothers and sisters,” added Duquette. “It’s about the mothers, the sisters, that are working hard and still cannot pay their bills, that get looked down upon on their job…How is it these bosses are killing their workers and their families, and they are not being held accountable? They’re not much better than the police.”

There’s little reason these workers will trust the government, due to the endemic racism they face. But they will trust their unions.

As COVID ravaged the US, employers – in health care as in meatpacking – faced little pressure from state or federal workplace regulators to improve safety, perpetuating racial disparities of workplace transmission and of community spread in the areas where essential workers live. Katie Murphy, an RN in the COVID ICU at Mass General Brigham in Boston and president of the 23,000-member Massachusetts Nurses’ Association (MNA), put it bluntly: “Nurses feel betrayed by their government. The response to this pandemic has been catastrophically bad.”

Pressure to improve safety instead emerged from the bottom up, as workers organized in their unions and communities to fight for safer conditions and protections on the job. In long-term care, the difference that such organizing made was measurable: a recent report showed that COVID mortality rates in unionized nursing homes in New York State were 30% lower than in non-union facilities. 

But these fights over safety had another effect. Unions emerged as a trusted source – in some cases, the only trusted source – for information about the new COVID vaccines for frontline workers, who feel that the government and their employers have misled them, exposed them to unnecessary risks, provided them with insufficient protection, and treated them as if they were disposable throughout the pandemic.

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It will take more than bribes or threats to get to a higher vaccination rate, both among health care workers and the general population. Experts agree that trust- and relationship-based education and outreach are key to vaccination efforts. What does such an effort look like close-up? One example can be found at Butler Hospital, a 166-bed psychiatric hospital in Providence, RI, which has about 900 employees. The frontline workers are organized nearly wall-to-wall in SEIU 1199NE — and according to several members of the union’s COVID safety team, as of mid-January, the staff’s vaccination rate had surpassed 90%.

The union’s rank-and-file leadership was pivotal in this achievement. Vaccine clinics were scheduled across all three shifts, but when the hospital announced that employees should make their appointment via work email, the union insisted upon a solution for workers whose jobs – like cleaning patients’ rooms or preparing and serving food – do not involve a computer. Besides such logistical fixes, however, was the issue of credibility. After hospital bosses decided in the spring to exclude housekeeping and dietary workers from its distribution of N95 masks, the union took to the streets to demand PPE for all.

Dawn Williams, an RN who has worked at Butler for 6 years and recently became a delegate, attributed much of the success of the vaccination effort to the union’s consistent stance for workplace safety and against such discriminatory treatment. “Education needed to be provided to all our staff, not just in their own language but by those they trusted,” Williams said. “It was the union that recognized that the erosion of trust that had taken place throughout this pandemic, especially within the large population of staff that spoke English as their second language, would deter them from getting the vaccine.”

The union proposed the idea of vaccine ambassadors: a group of union members including nurses and pharmacists who were, Williams said, trusted by “those that had no reason to trust administration or the government for that matter.” The ambassadors compiled information and answered their coworkers’ questions about the vaccine directly. When she later learned how many of her peers had chosen to take the vaccine, Williams said, “I had never been so proud to be part of 1199. That [90%] number represented hope for the future and the safety of my brothers and sisters of 1199.”

Without a doubt, such successes are easier in workplaces with an in-house pharmacy and vaccination capacity – and in settings where workers are organized across job classifications. But other lessons are also apparent: high workplace vaccination rates will not be achieved simply by posting a notice above the time clock and parachuting in a vaccinator for a few hours on one shift, or by having the same bosses who mistreat workers serve as the people recommending the vaccine.

People fundamentally misunderstand the role of unions in society. They are not just about money, though of course in a capitalist society money is the coin of the realm. They are about power, about mutual aid, about information, about democracy. No one hates unions more than a hospital administration. So it’s not surprising the workers trust their union a lot more than their bosses or the government.