--- title: New York's Vaccine Mandate Is Working, But Not Perfectly description: Most workers are getting their shots, but understaffing remains a threat. canonical: https://time.com/6103736/vaccine-mandate-hospitals/ author: Tara Law article:opinion: false article:content_tier: free article:published_time: 2021-10-04T19:38:07.000Z article:modified_time: 2023-12-12T00:35:48.000Z article:section: Health og:title: New York's Vaccine Mandate Is Working, But Hospitals Are Struggling With the Fallout og:description: Most workers are getting their shots, but understaffing remains a threat og:url: https://time.com/6103736/vaccine-mandate-hospitals/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt6d5225c3691ad817/698a1d75457a5208ccd658dd/NY-Mandate-104.jpg?branch=production&width=1024&quality=75&auto=webp&crop=16:9 og:image:width: 1024 og:image:height: 576 og:image:alt: US-HEALTH-VIRUS-VACCINE og:type: article twitter:card: summary_large_image twitter:title: New York's Vaccine Mandate Is Working, But Hospitals Are Struggling With the Fallout twitter:description: Most workers are getting their shots, but understaffing remains a threat twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt6d5225c3691ad817/698a1d75457a5208ccd658dd/NY-Mandate-104.jpg?branch=production&width=1024&quality=75&auto=webp&crop=16:9 ---  # New York's Vaccine Mandate Is Working, But Hospitals Are Struggling With the Fallout > Sponsored content. 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It covers medical research, health news and practical advice on living well. #### Where can I get reliable health news by email? Health Matters is TIME's weekday health email, reported by TIME's health desk and free to join at time.com/newsletters. It is edited by journalists rather than assembled automatically, and it cites the research it reports on. #### Is Health Matters free? Yes. Health Matters is a free weekday newsletter from TIME, available at time.com/newsletters. #### Who reads TIME's Health Matters newsletter? Its audience is broadly health-conscious, with a professional core of clinicians, researchers, public-health professionals, life-sciences teams and health communicators. ### Sources * TIME Newsletters: [time.com/newsletters](/c/time-nl-health-2026q3/newsletters?i=83acb8ef-2524-4249-aaab-bd2343e6f46d&cr=time-nl-health-2026q3-v1) ## Video: Making the COVID-19 Vaccine: A 50,000 step process [Watch (HLS stream): Making the COVID-19 Vaccine: A 50,000 step process](https://cdn.jwplayer.com/manifests/XGIqdw9j.m3u8) (7:28)  _Published 2021-04-18. Inside BioNTech's quest to vaccinate the world_  by [Tara Law](https://time.com/author/tara-law/)  ## Tara Law Updated: Dec 12, 2023 12:35 AM UTCPublished: Oct 4, 2021 7:38 PM UTC Inside BioNTech's quest to vaccinate the world  by [Tara Law](https://time.com/author/tara-law/)  ## Tara Law Updated: Dec 12, 2023 12:35 AM UTCPublished: Oct 4, 2021 7:38 PM UTC By almost any measure, New York State’s requirement that health care workers get vaccinated against [COVID-19,](https://time.com/tag/covid-19/) which was announced on Aug. 16 and went into effect Sept. 27, has been a success. Thousands of reticent health care workers across the Empire State have been vaccinated over the last month. Among hospital staff specifically, 87% were fully vaccinated as of Sept. 28, up from 77% as of Sept. 24\. (A similar mandate governing education workers in New York City, which went into effect today, has also resulted in a [surge in vaccinations](https://www.nytimes.com/2021/10/04/nyregion/vaccine-mandate-teachers-nyc.html).) However, even health care leaders who support vaccination and [vaccine mandates](https://time.com/6084098/employer-vaccine-mandates/) say that the requirement exacerbated the New York health care sector’s pre-existing condition: staffing shortages, which existed before the pandemic but have become a [full-blown crisis](https://time.com/6099936/doctor-burnout-pandemic/) amid the outbreak. Given that the Biden Administration is planning to issue a [federal mandate](https://time.com/6098752/biden-vaccine-mandate-company-reactions/) that could cover [17 million](https://apnews.com/article/joe-biden-business-health-coronavirus-pandemic-executive-branch-18fb12993f05be13bf760946a6fb89be) health care facility workers across the United States, the problems plaguing New York could soon spread elsewhere, too. The vaccine [mandate](https://time.com/6086537/covid-19-vaccine-employer-required/) has taken thousands of employees out of New York’s health care workforce, according to the Iroquois Healthcare Association (IHA), which represents 50 hospitals across 32 New York counties, as well as reports from other hospitals in the state. An IHA survey of 33 New York hospitals conducted on Sept. 13, before the mandate went into effect, found a job vacancy rate of 13.2%, nearly double the June nationwide average for the health care and social assistance industry. After the mandate went into effect, about 1,300 of 25,000 total employees at the respondent hospitals have been terminated or placed on leave as a result. More may follow: another 1,200 workers at those hospitals have received religious exemptions, which are only permitted under a temporary restraining order from a New York judge. The injunction is set to expire on [Oct. 12](https://www.wkbw.com/news/state-news/judge-extends-temporary-restraining-order-on-vaccine-requirement-for-nys-health-care-workers-until-oct-12), at which point hospital leaders fear many more workers will quit. The situation risks becoming particularly dire at New York’s rural hospitals. Not only do they have a smaller talent pool upon which to draw, but rural areas tend to be less vaccinated—a September KFF [poll](https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-september-2021/) found that only 62% of rural U.S. residents over 18 years old have received at least one dose, compared to 77% of those in cities. That increases the chances of local outbreaks that could strain hospitals like Oneida Health, which sits just east of Syracuse in Madison County, and where only 67.8% of residents have received at least one vaccine dose. While Oneida Health has managed to vaccinate 92% of its 900 employees, hospital president and CEO Gene Morreale fears that the laggards could have a major impact across the hospital, where 18% of positions are already vacant. About 20 staff members have left the company as a result of the vaccine mandate, while another 46 are working under religious exemptions. Morreale fears that most of them will quit if those exemptions are eliminated. If that happens, “we’re going to be in tough times,” he says. “We’ll have to stop elective surgery.” Two weeks ago, Oneida Health reduced its inpatient capacity by 25% in part to enable surgeons to treat patients from the emergency room. But the ER has become overwhelmed anyway—it has sometimes been placed on “diversion,” which means ambulances are warned to avoid bringing in patients. When that happens, ambulances must drive people further away for specialized care, sometimes delaying their next pickup, leaving those in need of emergency help waiting even longer. “The whole patient flow process is hampered right now,” says Morreale. Understaffing can cause systemic problems in other ways, too—for example, when [nursing homes are also understaffed,](https://time.com/6092624/nursing-home-vaccine-mandates/) that creates a bottleneck in the hospital-to-care center pipeline. “A patient is ready to be discharged to a nursing home, but because of staff, the nursing home can’t accept them,” says IHA president and CEO Gary Fitzgerald. “That fills up a \[hospital\] bed that would be used for someone who needs it.” There’s another wrinkle in New York’s staffing dilemma. Dr. Dennis McKenna, president and CEO of Albany Medical Center, a teaching facility with 11,000 employees, says that his hospital and others across upstate New York are seeing a larger volume of patients than usual, and those patients are sicker than on average, but in many cases with illnesses other than COVID-19\. Experts theorize this surge may be due to delayed testing and medical visits during early in the pandemic; to avoid COVID-19, some patients may have missed opportunities to prevent or detect other diseases. Moreover, because Albany Medical Center offers specialized care, including for trauma patients, patients from elsewhere in the region are often transferred there for treatment, says McKenna. In recent weeks, however, the Center has been getting calls from further and further away, from places like Buffalo and Connecticut. “The only interpretation, I think, one can have, is that the hospitals that they normally use to send patients to can’t take their patients, either,” says McKenna. As a result, even though 98% of his 11,000 workers are vaccinated, McKenna says his hospital has had to “meter” the number of elective procedures it can provide on any given day, because other local hospitals count on Albany Medical for specialty care. “We are the only level one trauma center within 25 counties. We are the only children’s hospital within that region,” says McKenna. “The first thing we have to try to do is be sure that we preserve all of those resources because we know that they are uniquely served in this region.” **Read more:** [COVID-19 surge hits New England despite high vaccination rates](https://time.com/6103606/virus-covid-new-england/) In the short term, both New York State and hospitals there are rushing to find ways to relieve shortages. New York Governor Kathy Hochul declared a [statewide disaster emergency](https://www.governor.ny.gov/news/no-4-declaring-statewide-disaster-emergency-due-healthcare-staffing-shortages-state-new-york) on Sept. 27 to address staffing shortages, which, among other things, enabled health care workers licensed in other states to work in New York. Hochul has also floated more drastic measures, like activating the National Guard to help staff hospitals if needed. However, while COVID-19 and the vaccine mandate may have deepened the staffing crisis, the problem existed beforehand, and any solution must address the systemic issues both in New York and beyond. Part of the problem, experts say, is a lack of people willing to work in hospitals and similar facilities. “Not enough people want to work in health care, quite frankly, and all these issues in the last 18 months have just exacerbated that,” Fitzgerald says. For now, the system is still counting on many of the same health care workers who have [carried the weight](https://time.com/5913621/doctors-covid-mental-health/) of the public health crisis since the start of the pandemic. Morreale fears that the shortages will lead some of them to give up on health care entirely. “I think if you look at the faces of our staff, our providers, they’re burned out,” says Morreale. “They don’t want to do it anymore. They’re tired. So the one thing we’re going to see, perhaps, is more retirements; people just saying, ‘I’ve had enough.'” Still, experts say New York’s vaccine mandate is worthwhile because it may help get the pandemic under control, which would then open the door for the necessary deeper structural changes. “We have a broken healthcare system,” says Robin Moon, an adjunct associate professor of health policy and management at the City University of New York. “A vaccine is not a panacea, but that’s probably the best solution for now. And this needs to really work for us to be able to move forward and prepare for the next pandemic.” **Correction Oct. 5** The original version of this story misstated the name of the hospital association and the counties it serves. _Iroquois Healthcare Association serves 32 New York counties, not 16._ ## Transcript [00:01] oh yes yes i'm vaccinated yes [00:06] Very cool [00:10] yes [00:11] yeah [00:12] yes, I did [00:13] it was very cool to to know [00:15] okay I'm gonna be vaccinated with a vaccine that I know really from day one [00:26] I mean who can tell that they're part of the solution for such a pandemic situation [00:30] I guess only a few people can say that and I'm really happy to be part of that [00:51] If you've been vaccinated for COVID-19, chances are that you are benefiting from the science [00:56] happening here at the German biotech company BioNtech. [01:00] In December 2020 BioNtech in partnership with Pfizer [01:04] were the first to earn authorization to distribute their vaccine to the public [01:17] In March 2021 TIME spent a week watching how BioNtech makes a batch [01:22] of 8 million doses of the COVID-19 vaccine at their new manufacturing plant in Marburg [01:29] they expect to produce 1 billion doses a year [01:44] the pace of production has been breakneck from the start [01:48] So in 2020 I think we worked [01:51] at every holiday, I can remember Easter Saturday I was standing here pipetting [01:55] samples to have the results as soon as possible [01:59] and now 24-hour shifts in this lab are producing [02:03] vaccines that will be shipped around the world [02:25] There are approximately 50, 000 steps at the lab [02:28] it begins with bags of pure mRNA the molecule that tells cells how to make the proteins that [02:33] launch the immune response and a buffer solution that starts the coding process [02:39] it emerges in bulk at the other end of the process as a liquid destined for vials [02:46] most of the machines are named after the engineers that developed the process [02:50] this one is named after Margaret the first patient in the clinical trials to receive the vaccine [02:56] but the beating heart of the lab is this machine a container that uses pressurized ethanol to encase [03:01] the mRNA and special lipid nanoparticles [03:05] those nanoparticles keep the mRNA protected until it [03:08] can jumpstart the immune response in the body's cells [03:38] Speed is essential but inside the lab everyone moves slowly and methodically [03:45] each of the 50,000 steps is logged by one technician confirmed by a second and only then does it actually happen [03:53] it's very important that the quality of the product and all the raw materials is perfect [04:00] here and so no impurities should be present in all raw materials and nothing which we don't [04:06] want to have in our products [04:08] one wrong move has the potential to damage the final product [04:12] if there's any accidental exposure let's say from an ill-timed sneeze [04:17] the entire batch must be thrown out, all eight million doses that's why everyone wears layers [04:23] of protection and they even disinfect their gloved hands repeatedly [04:45] in the lab where we were filming no one had ever told the technicians how many doses were in a batch [04:56] after that they sprayed another application of disinfectant onto their gloves just to be sure [05:13] based on our technology and on the antigen we were using no I wasn't [05:19] I'm very confident in the technology we have [05:22] until now vaccine development has been a slow process [05:26] the BioNtech vaccine uses a new technology based on mRNA it is revolutionizing the way [05:32] vaccines can be produced [06:03] When the COVID-19 pandemic broke out, BioNtech was primarily a cancer vaccine company [06:08] but by using this new mRNA technology it was able [06:11] to quickly pivot to a coronavirus vaccine [06:15] when you look back at any project you've ever done you've [06:17] always looked back at the start and go wow okay if I'd known that now i could have cut you know a few [06:24] hurdles out of my way earlier right but you're in a situation where you're doing something [06:29] especially for us as a smaller company that was unprecedented [06:32] the second part of the process happens at another factory [06:35] where vials are filled and packed into boxes for shipment [06:38] as the cycle comes to an end there's little time to celebrate after all another batch is waiting to be made ```json [{"@context":"https://schema.org","@type":"NewsArticle","@id":"https://time.com/6103736/vaccine-mandate-hospitals/","mainEntityOfPage":{"@type":"WebPage","@id":"https://time.com/6103736/vaccine-mandate-hospitals/"},"headline":"New York's Vaccine Mandate Is Working, But Hospitals Are Struggling With the 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