Health care workers and first responders were the first to be offered COVID-19 vaccines after a year on the front lines treating and caring for patients with the virus.

Oftentimes, they acted as a loved one and caregiver simultaneously, taking on personal risk as they ushered patients through what could be brutal and long recoveries or deaths.

But after nearly a year of trauma, it’s unclear how many health care workers decided to get inoculated in Washington. The same is true for first responders , many of whom turned down the vaccine despite being offered early access and being at high risk of infection.

Due to a lack of federal and state data, only surveys and individual providers can offer snapshots of how much of the workforce received a vaccine.

In Spokane, hospitals will not disclose how many of their employees are vaccinated, so it is impossible to see how they compare to hospitals elsewhere in Washington.

At the University of Washington Medical system, more than 20,000 employees have been vaccinated, and only 8% of employees who are eligible have refused a shot.

At Overlake Medical Center in Bellevue, Dr. Amy Markezich, a critical care physician, said her pulmonary team and critical care unit were approaching a 100% vaccination rate.

In Moses Lake, Samaritan Hospital is approaching 50% of caregivers vaccinated, according to Dr. Andrea Carter, chief medical officer there.

Pullman Regional Hospital coordinated a precise campaign to inoculate a goal of 75% of its staff this year. They are nearly there at 74% of all staff vaccinated.

Both Spokane hospital systems, MultiCare and Providence hospitals, will not offer data on their vaccination efforts.

“We’ve had an overall positive response to the vaccine from our employees and have been pleased to see so many employees advocating for the vaccine amongst their family and friends,” according to a statement from MultiCare. “We have heard from some employees who are working remotely that they have chosen to wait longer to receive a vaccine so that the initial supplies could go to more vulnerable members of the community.”

Both Providence and MultiCare health systems said some of their caregivers were vaccinated outside of the health systems they work for.

“We know that some caregivers have chosen to get their vaccines elsewhere (and therefore it’s not recorded by our caregiver health department),” a statement from Providence says. “We also have a large portion of caregivers who are still working from home so the urgency to be vaccinated is not there until they return to the hospital setting.”

While hospitals might be tracking this data, they do not have to share it and it may not be complete. Current vaccine registration guidelines do not include “occupation” as a necessary field on registration forms, according to the Washington Department of Health.

Tracking a patient’s occupation is not required by the Centers for Disease Control and Prevention .

“There are privacy rules about what can be asked. These limitations make it difficult to add more questions such as occupation to the standard format,” according to a statement from the Department of Health. “Instead, we need to rely on other approaches such as surveys or statistics from employee-based vaccine outreach efforts to gather complementary information.”

The Department of Health did survey health care providers to get a snapshot of first-phase vaccine recipients, but they did not have aggregated results to share.

Surveys and direct data from providers is the best information available.

A Washington State Hospital Association survey of 20 hospitals found that an average of 30% of hospital staff members were passing on the vaccine.

Examining hesitationAt Pullman Regional, Jeannie Eylar, chief nursing officer, is pleased with the vaccination efforts among the 518 staff members there so far, noting that the 74% vaccination rate is much higher than what she’s learned from other hospitals.

She said that some of the staff members who are not getting vaccinated currently are pregnant or nursing mothers, wary of the limited data around the effects of the vaccine on them and their newborn babies.

Pregnant women were left out of initial vaccine trials and only recently were made eligible to be vaccinated in Washington after studies specifically looking at the safety of the vaccines for pregnant women have been published.

Eylar said some staff members are waiting to get the Johnson & Johnson vaccine instead of the Pfizer and Moderna vaccines. That vaccine requires only one shot, while Pfizer and Moderna both require two doses.

In general, frontline staff who have cared for COVID-19 patients are more likely to get the vaccine than those in other departments at Pullman Regional.

This trend is similar elsewhere.

“Nationally, that’s what we’re seeing, is that folks in the medical and nursing community have been really excited for the most part,” said Dr. Santiago Neme, a physician who specializes in infectious disease at the UW Medical Center.

Historical hesitancy due to racist and unethical treatment of Black Americans and other people of color can also contribute to vaccine reluctance.

“So there’s a hesitancy because of history, and some hesitancy of people who want to wait and see and didn’t want to be the first to jump,” Neme said.

Education and colleague empowermentUW Medical conducted an intensive and all-encompassing vaccine information campaign, including information sessions in 11 languages, Neme said. He hosted some sessions in Spanish.

“The idea here is to provide information to staff about the safety (of the vaccines) and how they work,” Neme said.

As time has gone on, since many health care workers have been vaccinated with no adverse effects, their stories can help instill confidence in others.

Pullman Regional Hospital asked employees to tell their stories of why they got vaccinated.

“We didn’t create those messages,” Eylar said. “We put a call out to employees who wanted to share, and I would guess we had about 50 people share their stories.”

Those stories ended up helping make other caregivers comfortable, Eylar said. Making sure that caregivers could be vaccinated on their schedules was also important to ensuring access for Pullman Regional employees. This meant the pharmacy team had to be flexible on timing for staff vaccine clinics, Eylar said.

The hospital also purchased pins for employees who have been vaccinated .

“It is transparent about who’s been vaccinated and who hasn’t, and that’s because it’s not just about our personal choice but the good of the public,” she said.

It’s a balance, however.

“At the same time, we’re trying to be respectful of those trying not to get the vaccine,” she said.

A nationwide survey of health care workers by the Washington Post and the Kaiser Family Foundation published this month found that 52% of those surveyed had received at least one COVID-19 shot.

Data limited, uptake mixed in local first respondersDespite being considered at high-risk of contracting the disease, only about half of the first responders in Spokane County signed up to receive the shot.

Organizers of the vaccine clinic for local first responders in January were happy with the way it was run, but had hoped more people would opt to participate.

Firefighters, EMTs, and police officers are not required to receive the vaccine, but had been urged by public health officials – and their own bosses – to do so as quickly as possible.

About 1,110 first responders – or 48% – received the vaccine at the clinic established by the Spokane Regional Health District and the Spokane County EMS and Trauma Care Council.

“I was kind of hoping for 60 to 65% , but obviously it’s a new vaccine,” said Mike Lopez, Spokane Fire Department’s medical services director. “I think there was some skepticism, there was some concern.”

Some were excluded because they had tested positive for the virus within the last 90 days. Officials figured that people who haven’t recently had the virus would not have antibodies to fight disease, and thus should be prioritized for vaccination.

But others just didn’t want to be the first in line for a new vaccine and were worried about its side effects.

“We educated our folks on the benefits of the vaccine,” Lopez said. “It still boiled down to personal choice.”

Spokane is hardly the only region experiencing the phenomenon.

In Washington, D.C., fewer than half of the city fire department’s 2,200 person workforce had been vaccinated, local TV station AVC7 reported last month. Similar trends have been documented throughout the country.

In Spokane, those who choose not to get vaccinated aren’t reassigned or punished .

The number of first responders who have been vaccinated has surely grown since the initial clinic, but individual agencies aren’t keeping track.

Lopez said about 40 additional first responders who didn’t qualify for the first clinic due to the 90-day rule have been vaccinated .

About 117 of the Spokane Valley Fire Department’s employees have been vaccinated, including 10 who were initially excluded, according to spokesperson Julie Happy.

“We did not track why they chose not to get shots during the first administration. We also know there were some who got the vaccine elsewhere, but we are not tracking that information,” Happy wrote in an email to The Spokesman-Review.

The Spokane Police Department estimates that a little less than half of its employees are vaccinated, although it can’t know for certain how many officers may have chosen to get the vaccine privately.

Spokane police spokeswoman Julie Humphreys said officers who don’t get vaccinated aren’t reassigned, but all officers are expected to continue safe practices like standing back from a vehicle after they pull over its driver.

“What do you do with that? If you’re a grocery store, you can’t ask your employees to get vaccinated, but can you require them to wear a mask?” Humphreys said.

Tim Archer, president of the Spokane Firefighters Union, said firefighters who have expressed hesitancy typically cite the same reasons as the general public.

“It’s been a myriad of reasons and I think we’re a pretty good reflection of Spokane citizens – everything from personal concerns to other health issues that might get complicated by it,” Archer said.

Mark Gregory, a spokesman for the Spokane County Sheriff’s Office, said it has provided opportunities to receive the vaccine but cannot legally ask employees if they’ve opted to do so.

“It is an individual’s choice to receive a vaccination, not a requirement by us,” Gregory said.

Estimates on the threshold required for herd immunity vary, but all are well above 50%, Lopez noted.

The January clinic was efficient enough – and demand was low enough – that it was able to vaccinate front-line healthcare workers at the request of the Spokane Regional Health District, according to Lopez.

Although only 1,110 first responders were vaccinated, the clinic distributed more than 5,000 doses.

“The goal of the EMS council was to make it available to every first responder whether they chose to get a vaccine or not. We were able to meet that goal,” Happy said.