Dr. Melisha Cumberland, the chief of medicine at Windham Hospital, receives the COVID-19 vaccine. Yehyun Kim / ctmirror.org
Dr. Melisha Cumberland, the chief of medicine at Windham Hospital, receives the COVID-19 vaccine. Yehyun Kim / ctmirror.org

At Bristol Health, a small independent health system with 1,800 employees, 98% of workers were vaccinated by the Sept. 15 deadline. But while the hospital’s mandate to get vaccinated for COVID has pushed the majority of those previously unvaccinated to get a shot, it also has resulted in a spike in workers receiving religious exemptions.

Bristol approved 46 applications for COVID vaccine exemptions this year, 39 of which were granted on religious grounds. It also granted 26 exemptions for the flu vaccine this year, 23 of which were granted on religious grounds. In short: Bristol has approved nearly twice as many religious exemptions for the COVID vaccine as it has for the flu vaccine.

Unlike businesses in other industries, all hospitals in the state have the unique ability to look to flu vaccinations as a point of comparison in exemption applications and approvals. In 2011, the Connecticut Hospital Association recommended that hospitals adopt flu vaccine mandates, and all Connecticut hospitals currently have a flu vaccine mandate in place, said spokesperson Jill McDonald Halsey.

The comparison between coronavirus and flu vaccines isn’t perfect, since the production process may differ in a key respect: some COVID vaccines are produced using fetal cell lines while influenza vaccines are not derived from fetal cell lines. Some people opposed to abortion on religious grounds have cited fetal cell use as a reason not to get vaccinated — even in cases of the influenza vaccine where the argument has no bearing, research has shown.

As they sifted through exemption applications, hospital executives have had to grapple with “whether or not this is a seriously held religious belief versus just vaccine hesitancy,” said Christine Laprise, a human resources and operations executive at Bristol Health.

Bristol is not alone in seeing a spike in applications and approvals for religious exemptions for COVID vaccines. In interviews with The Connecticut Mirror, Yale New Haven Health and Hartford HealthCare reported seeing the same trend in their numbers. The Connecticut Hospital Association has also heard anecdotal reports of increased numbers of religious exemptions across the board in Connecticut hospitals, said Paul Kidwell, senior vice president.

“Certainly, the number of religious exemptions that are being sought for the COVID vaccine is much larger than the same number of exemptions being sought for the flu vaccine on an annual basis,” he said.

At Yale New Haven, applications for exemptions have ticked up on both the medical and religious fronts, but more so for religious reasons, said Dr. Ohm Deshpande, associate chief clinical officer at Yale New Haven Health. The criteria for seeking out medical exemptions for the COVID vaccines are more stringent than those in place for religious exemptions, he added.

Officials approved about 600 total exemptions to the COVID-19 vaccine, many of them religious, while it has authorized about 500 total exemptions for the flu vaccine, Deshpande said.

“We saw a significant number of applications,” he said. “A fair number of them were denied.” Of 855 requests for religious exemptions for COVID vaccines, 449 were approved and 416 denied, according to numbers provided by spokesperson Mark D’Antonio. Yale New Haven did not explain how many of the approximately 500 exemptions for the flu vaccine were religious or how many were denied.

Yale New Haven offers an appeal process for those who are refused an exemption, and “a number are going through that,” Deshpande said.

The health system has about 30,000 employees, and 95.83% were either partially or fully vaccinated on Tuesday.

At Hartford HealthCare, about 1,000 employees have sought out exemptions so far, the majority for religious reasons, said Dr. Ajay Kumar, executive vice president and chief clinical officer. Kumar declined to be more specific in an interview Tuesday as the system’s mandate deadline had yet to pass.

The number represents an increase from the number of influenza exemption requests the system typically sees. In 2020, Hartford HealthCare approved 573 applications for flu exemptions, and 25% were on religious grounds, wrote spokesperson Tina Varona.

“There’s definitely a difference between exemption requests for COVID vaccines and the flu vaccine,” Kumar said.

Overall, 98% of 34,000 employees and contractors were vaccinated at Hartford HealthCare as of Thursday morning.

All three hospitals said they had not observed any patterns in the positions held by employees seeking out religious exemptions.

“It was actually surprisingly just pretty consistent across the board,” Laprise said. “From your environmental service workers to an RN to a medical assistant to basically essentially every area, we had some some individuals expressing or submitting either religious exemptions or medical exemptions or electing not to move forward.”

Some researchers and health officials are questioning why more employees have sought religious exemptions to the coronavirus vaccine than to the flu shot.

“Rather than quit, which most people really don’t want to do and face unemployment, loss of pensions, loss of health insurance, you’d expect them to look for loopholes. So, no surprise,” said Arthur Caplan, professor of bioethics at New York University Grossman School of Medicine.

“You would think that anybody who had a religious exemption to a flu vaccine would have a religious exemption to COVID vaccine, and vice versa,” said Ted Doolittle, the state’s health care advocate. “You wouldn’t expect to see a religious difference there.”

How do hospitals determine if a belief is ‘sincerely held?’

Decisions on who gets a religious exemption and who doesn’t are often made by a group of people in a hospital setting, rather than a single person.

In many cases, a chaplain or other religiously affiliated employee will serve on the panel, along with officials from the human resources department and other administrators.

Applicants are asked to describe in writing their sincerely held religious beliefs and how long they’ve held them. The panel may ask follow-up questions.

“Many of the requests have to do with an objection to the use of fetal cell lines. In some instances, hospitals have asked if an individual is currently taking medication that also was developed using those cell lines,” Kidwell said. “So, we’re getting a little bit deeper into some of the items highlighted by the individuals seeking the exemption.”

Applicants must be clear and contextual. Exemptions may be denied if the seeker doesn’t “take the time to actually describe the belief or why it’s strongly held,” Kidwell said.

“A sentence-long application that doesn’t provide any information around the source of the belief, why they believe what they do, how long they’ve held the belief in this instance, and why that belief runs counter to being vaccinated – I think that would be a reason why it may be denied or where the hospital would go back and ask for some additional information,” he said.

At Bristol Health, administrators sometimes ask for a letter from a pastor or other religious official if the applicant belongs to a parish.

“It really is an interactive process in understanding whether that individual’s belief falls under a seriously held religious belief, rather than it being some sort of opinion or vaccine hesitancy,” Laprise said. “We’ve had attorneys assist us in that process as well.”

Objections to vaccination along religious lines may stem from ethical objections to abortion. The Vatican has issued a statement supporting COVID vaccination.

Caplan has little patience for those who cite fetal cells as a reason not to get vaccinated. “Almost every drug and over-the-counter product has been tested on fetal cells,” Caplan said. “If you really held that objection seriously — if you didn’t just make it up to get out of vaccination — you would not be able to go to the hospital, and you couldn’t go to the drugstore.”

“I’m going to say, bluntly, that is people grasping at straws,” Caplan said.

Kidwell said he did not know of any hospital that is facing challenges under Title VII of the Civil Rights Act, which protects against discrimination on the basis of religion. Employees who believe that they have been wrongly denied an exemption may first go through a hospital’s internal appeals process.

In general, religious exemptions probably aren’t going to be the loophole that some people opposed to vaccination hope it will be, Caplan said.

Employers are required to accommodate religious beliefs if they do not cause “undue hardship” for them. An accommodation would be considered a hardship “if it is costly, compromises workplace safety, decreases workplace efficiency, infringes on the rights of other employees or requires other employees to do more than their share of potentially hazardous or burdensome work,” according to the U.S. Department of Labor.

“An employer can still refuse a claim of religion. They have to try and accommodate you,” Caplan said. “There may be some jobs where you can work at home and you don’t see anybody, and the employer will keep you on, but none of those are in health care.”

Health systems that hand out exemptions should have added precautions for unvaccinated staff, such as weekly testing, Doolittle said. Some hospitals, such as Hartford Hospital, are taking that step.

“People are concerned about going to places or receiving care from folks who aren’t vaccinated, regardless of the reason for it,” Doolittle said. “From the perspective of a vulnerable person, it doesn’t matter whether it’s a religious exemption or some other philosophical or political reason for not getting vaccinated – you want the people to be vaccinated. These places really should have strict mask and testing mandates for anybody who is not vaccinated.”

Kasturi was CT Mirror’s data reporter. She is a May 2020 graduate of the Columbia Journalism School’s master’s program in data journalism and holds a degree in comparative literature from Brown University, where she was editor-in-chief of the student newspaper. Prior to joining CT Mirror, Kasturi interned for publications in India.

Jenna is CT Mirror’s Health Reporter, focusing on health access, affordability, quality, equity and disparities, social determinants of health, health system planning, infrastructure, processes, information systems, and other health policy. Before joining CT Mirror Jenna was a reporter at The Hartford Courant for 10 years, where she consistently won statewide and regional awards. Jenna has a Master of Science degree in Interactive Media from Quinnipiac University and a Bachelor or Arts degree in Journalism from Grand Valley State University.