Exclusive: New York Tells Hospitals In Leaked Email That Staff ‘Must’ Come Before the Elderly In COVID-19 Vaccination Drive

The state of New York has warned hospitals that they cannot start giving COVID-19 vaccines to elderly people until they finish vaccinating hospital staff members, according to an email sent to hospitals across the state just before midnight on Feb. 5 from the governor’s vaccination chief, and obtained by TIME this week.

The memo from Larry Schwartz, an adviser to Governor Andrew Cuomo who is overseeing the vaccination drive across the state, presents a dilemma for some New York hospitals, which have faced widespread hesitancy among staff members to take the vaccine. Schwartz’s email says that hospitals cannot vaccinate other segments of the population—such as the elderly and those with chronic diseases—until they are done vaccinating their medical workers. “If, and only if, all phase 1a eligibility groups been exhausted hospitals may vaccinate individuals in the 65+ category,” Schwartz wrote in his email on Friday night, referring to the highest priority group for vaccination, known as “Phase 1a,” which includes frontline health care workers.

In an interview on Thursday, Schwartz told TIME that the memo was not intended as a threat to punish hospitals for failing to vaccinate their staff. “In no way was the message about penalizing anyone,” he says. If hospital workers later decide to get a vaccine, they will still be able to receive one. They will also continue getting doses to vaccinate other vulnerable populations, Schwartz said. But in the coming days, he does expect a drop in the number of vaccines sent to hospitals as New York moves on to vaccinating other priority groups, such as the elderly, at other vaccination sites. “We are going to reduce their overall allocation,” he said, referring to hospitals.

The memo alarmed some New York hospital administrators, who fear that they will not have enough vaccine doses to distribute in their community. “These decisions are false choices,” says Ramon Rodriguez, the President and CEO of Wyckoff Heights Medical Center, where slightly more than half of employees have declined to take the vaccine. The doses meant for those employees have instead gone to sick and elderly patients from the parts of Brooklyn and Queens that Wyckoff serves, Rodriguez says. “We get the doses and we use them,” he says. “Our vaccinations are more targeted towards sick people who are chronically ill because this is the place they know to go to. We are their health care provider.”

In a televised briefing on Monday morning, Governor Cuomo lamented the fact that some New York hospitals had only been able to vaccinate 40%-50% of their staff. The average rate, he added, had reached 75%—a level that Cuomo called “the maximum rate that these hospitals can get done.” He did not say that hospitals would face any consequences for having a low rate of staff vaccinations. “Hospitals can’t say to a nurse, ‘you must take the vaccine,'” the governor said. “The nurse has the right to decline, but I want to make sure every nurse had the option, every doctor had the option to take that vaccine. If they don’t want to take it at one point we understand, and we’ll give it to somebody else. So this is the last week for that.”

In his email to hospitals, Cuomo’s vaccination chief appeared to take a tougher tone, suggesting that hospitals could not move beyond the first phase of the vaccination rollout until they schedule shots for their staff members. “You must schedule those employees before you do any other eligible 1a populations,” Schwartz wrote (emphasis his), noting that there are still about 24,000 medical workers who have not yet scheduled a vaccination at their hospitals. “Only upon completion of vaccinating eligible hospital employees, may your hospital move on to vaccinate” other high-priority groups outside the hospital, he added.

The memo does not explain how hospitals are expected to vaccinate workers who refuse to get the shot. Under state and federal guidelines, hospitals are not allowed to mandate vaccination among their staff. The U.S. Centers for Disease Control and Prevention has recommended a strategy of “focused communication and outreach” in order to convince health care workers to be vaccinated.

That strategy has not worked for some New York hospitals. At least 13 of them across the state have not been able to vaccinate even half of their staff, according to figures the governor released on Monday.

“I’ve begged people,” says Rodriguez, the hospital CEO. “Many have changed their minds, but others are waiting.”