Hospitals coast to coast are demanding their employees get vaccinated against covid as the highly contagious delta variant tears through populations with low vaccination rates.

Nearly 1,500 hospitals — roughly a quarter of all hospitals in the U.S. —now require staffers to get a covid vaccine, said Colin Milligan, a spokesperson for the American Hospital Association. More follow suit every day as hospital leaders aim to head off staff shortages like those experienced last year and to keep employees from becoming vectors of the disease.

But that’s not an option in Montana, where a law passed this year amid a pandemic backlash prohibits employers, including most health care facilities, from mandating any vaccine for their staffs. Nor is it in Oregon, where a 32-year-old law similarly bans vaccine mandates for health workers.

At least seven states have enacted laws to prevent covid vaccine mandates or so-called vaccine passports that would provide proof of vaccination, according to the National Academy for State Health Policy. Most restrict only state and local governments or specifically exempt health care facilities, but Montana’s law goes further. It prohibits employers — including hospitals — from discriminating against a worker based on vaccination status. Employers can’t require vaccinations and workers don’t have to tell their bosses whether they’re vaccinated.

That worries hospital leaders as covid hospitalizations hit levels not seen nationally since February. In Montana, covid hospitalizations had nearly doubled at the beginning of August compared with two weeks before, and about 90% of covid patients hospitalized at the end of July hadn’t been vaccinated, according to the Montana health department’s most recent data.

“I cannot imagine passing any worse law than that,” said John Goodnow, CEO of Benefis Health in Great Falls. “Imagine if that would have been passed back when we were fighting polio, or smallpox before that.”

Benefis had announced plans to make the vaccine mandatory for its 3,400 staffers back in April, before state lawmakers passed the bill preventing the hospital from doing so.

Those who back the law said it’s an issue of personal rights.

“Your health care decisions are private, they’re protected by the constitution of the state of Montana,” Rep. Jennifer Carlson, a Republican, said in March as she introduced the bill. “And your religious rights are protected.”

Health care professionals are more likely to be vaccinated against covid than the general population. Nonetheless, there remain nurses, doctors and other hospital employees who work directly with patients who are hesitant or resistant to inoculation, especially in rural regions.

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Dr. Greg Tierney, chief medical officer of Benefis, said he’s concerned about potential rancor between vaccinated and unvaccinated staff members as their workload rises with the caseload.

“You have the people who have been vaccinated looking at the person next to him who’s choosing not to,” Tierney said. “Whereas, they were literally brethren in arms.”

In northwestern Montana, a region with a 34% vaccination rate to date and the epicenter of the state’s latest surge, Logan Health officials said existing staffing shortages are worsening as health care workers become infected or must quarantine. Chief medical officer Dr. Doug Nelson said the shots have been proven safe and effective, and Logan would likely consider a staff vaccine mandate if state law allowed it.

“Wearing a mask whenever you’re in our facilities, that helps, but being able to vaccinate everyone would help more,” Nelson said.

In Billings, Montana’s most populated city, the Billings Clinic’s intensive care unit reached capacity the first week of August and officials started shifting patients to overflow beds. At that time, roughly 60% of the system’s employees reported being vaccinated.

Hospital leaders are hosting weekly town halls to answer clinic workers’ vaccine questions or try to dispel myths in between caring for a growing number of covid patients.

“Knowing there are solutions out there that can help prevent this from happening, like simple vaccination, makes you frustrated,” said Dr. Fernando Caceres, an intensivist in Billings Clinic’s ICU.

In July, nearly 60 major U.S. medical organizations called for employers to mandate all health and long-term care workers get vaccinated in a joint statement that included the American Medical Association and the American Nurses Association. The Department of Veterans Affairs gave health care personnel eight weeks to get the shot.

In August, California became the first state to order workers in health care settings to be fully vaccinated and for visitors in health settings to show proof of vaccination or a negative covid test. And in Massachusetts, Republican Gov. Charlie Baker ordered most nursing home workers to get the jab by October 10, citing a massive increase in cases among staffers and residents.

Some hospitals have had to enforce their mandates. In Texas in June, Houston Methodist fired or accepted the resignations of more than 150 health care workers who didn’t get the jab.

Trinity Health — a Catholic health system with 117,000 workers across 22 states — said employees without a shot or exemption would be fired.

“Trinity Health has counted our own colleagues and patients in the too-high coronavirus death toll,” Mike Slubowski, the organization’s president and CEO, said in the announcement. “Now that we have a proven way to prevent covid-19 deaths, we are not hesitating to do our part.”

How Trinity’s policy will work in Oregon, where the three-decade-old law prevents vaccine requirements, is unclear

Attempts to change the law won’t happen before next year’s legislative session, Democratic Gov. Kate Brown said. In the meantime, she issued a rule last week to pressure health care workers to get vaccinated, saying they will face weekly covid tests if they don’t — and their employers will foot the bill.

“This new safety measure is necessary to stop delta from causing severe illness among our first line of defense: our doctors, nurses, medical students and frontline health care workers,” Brown said in the statement. Before Brown’s announcement, Kaiser Permanente, a national health system based in California, had said all of its employees must be vaccinated against covid — even those in Oregon. (KHN, which produces California Healthline, is not affiliated with Kaiser Permanente.)

After Brown’s announcement, KP spokesperson Michael Foley said those who don’t get the vaccine in Oregon will undergo weekly testing; employees in other states, however, will have to apply for medical or religious exemptions or find a new job if they refuse to be vaccinated.

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