“People aren’t thinking about us”: How new ban on COVID-19 vaccine mandates impacts medically-vulnerable Texans

Alice Barton looks through a rack of homemade masks in her South Austin home on Nov. 10, 2023. A bill signed on Friday, which bans vaccine requirements on all private businesses, could risk the health of groups like organ transplant recipients, cancer patients and those with underlying conditions as common as severe asthma (Credit: Julius Shieh/The Texas Tribune)

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A sweeping ban on COVID-19 vaccine requirements for all private businesses, including hospitals, is the latest blow to medically vulnerable Texans who rely on others’ immunization to shield themselves from highly transmissible viruses.

Tamer coronavirus variants and a soft vaccine booster rollout have contributed to a lessened sense of urgency around the virus. But the new measure, which Gov. Greg Abbott signed into law on Friday, could risk the health of groups like organ transplant recipients, cancer patients and those with underlying conditions as common as severe asthma.

These risks led to some bipartisan dissent during original Senate discussions of the bill, especially from state Sens. Borris Miles, D-Houston and Kelly Hancock, R-Fort Worth, who both take immunosuppressants for their respective kidney transplants.

“I live a pretty normal life and am not fearful, but it does make you think about others,” Hancock said. “There's just a balance we have to keep in mind — just try to always think of others and the positions they may be in.”

For one, vaccines are less effective in some of these patients because their conditions prevent their bodies from manufacturing the white blood cells that can recognize and fight off viruses. But even with protection, the virus can exacerbate underlying conditions and lead to long-term symptoms of the virus, known as long COVID.

Scientists and health experts agree that the vaccine is safe and effective for most people with functioning immune systems, in reducing both transmission and severity of the virus.

“Everybody’s going to be different, so it's not automatic that a compromised individual will end up in the hospital or in the ICU,” said Dr. Jimmy Widmer, an internal medicine specialist. “But what we do know throughout the past three and a half years of COVID, is that time and time again, study after study has shown that those who are immunocompromised are hospitalized at a higher rate.”

Gov. Greg Abbott signs a bill which bans COVID-19 vaccine requirements for all private businesses at the Governor's Mansion in Austin on Nov. 10, 2023. (Credit: Julius Shieh/The Texas Tribune)

In the past, state lawmakers’ efforts to stymie vaccine mandates have excluded hospitals and other medical facilities — partially because under federal emergency rules, the U.S. Centers for Medicare and Medicaid Services required vaccinations among employees.

The regulation was withdrawn over the summer, and since then, many facilities have differed on their rules. A “vast majority” of them did not even have a blanket mandate at this point, said Carrie Kroll, an advocacy leader for the Texas Hospital Association.

“We’re very hopeful that the worst of the COVID pandemic is behind us,” Kroll said. “But we know with infectious disease, what may rule today may not rule in six months, in terms of disease levels and what this disease morphs into.”

In the end, lawmakers included a provision that would allow hospitals to require unvaccinated employees to wear personal protective equipment despite advocates fighting for a complete exclusion from the bill.

Alice Barton, a retired infectious disease doctor living in Austin, said it's “impossible to imagine” this measure will be enforced. Barton, 70, has severe asthma and an autoimmune disease, and said she just received the triple vaccine for the flu, COVID, and RSV.

“I'm the only person still who wears a mask to the doctor's office. I'm one of two people in my church who wears a mask,” Barton said. “One becomes lonely. It's not just being physically isolated from other people. It's that other people aren't thinking about us anymore.”

Barton is one of many people worried that state lawmakers will continue further down the warpath against vaccine requirements, onto other immunizations like those for polio or measles.

But, with the law now in place, advocates hope to transform the idea that people “have” to get the vaccine into an idea that they “should” to protect their peers.

Barton, a retired physician, has severe asthma and an autoimmune disease and continues to take precautions such as masking. (Credit: Julius Shieh/The Texas Tribune)

Chase Bearden, a leader at the Coalition of Texans with Disabilities, said now that there’s less external pressure on Texans to make this decision, he hopes they realize it’s one they can make of their own accord.

“What can we all do on a personal level to keep everyone safe, especially those who may not have the great health that the rest of us do?” Bearden said. “There’s so many family members that are going through cancer treatment or living with a chronic health condition. And yes, you're a healthy person. You don't think you need it. But if you get it, you easily pass that on to the next person who takes it home.”

Stephanie Duke, an attorney who helps handle disaster management at Disability Rights Texas, said the state should be doing everything it can to promote public health, and that should include people with disabilities.

“People go in to get health care, and you would expect your health care provider to be doing everything they can to make that safe,” Duke said.

Duke said government officials often forget to include disabled people in disaster preparedness, and the global pandemic was no different than a hurricane evacuation. Several policies issued during the height of the public health emergency have hurt those who don’t have functioning immune systems or with chronic illnesses.

For instance, when the pandemic began, disabled people weren’t a specific category included in the demographic data that states began collecting on the virus, she said.

“Shit is going to happen. Lights are going to go out, we're going to have viruses again. This is the world that we live in,” Duke said. “But how we plan for it, is how we give people choices to promote their safety, autonomy and independence after an event and build that resilience.”

Neelam Bohra is a 2023-24 New York Times disability reporting fellow, based at The Texas Tribune through a partnership with The New York Times and the National Center on Disability and Journalism, which is based at the Walter Cronkite School of Journalism and Mass Communication at Arizona State University.

Disclosure: Coalition of Texans with Disabilities, Texas Hospital Association and The New York Times have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.