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Healthcare workers have been gradually coming around to COVID-19 vaccines, with one-third more people vaccinated since earlier in the year, but 27 percent of them are still unvaccinated, and 15 percent of the unvaccinated group are firmly opposed to immunizations. More healthcare employers may be pressured to mandate immunizations to stave off contagious Delta variant infections.

“The fact that 27 percent of staff in healthcare facilities are currently unvaccinated poses a significant risk to vulnerable patients, which will likely exacerbate outbreaks in healthcare settings,” according to the study from the Covid States Project, a collaborative effort by researchers from Northeastern, Harvard, Northwestern, and Rutgers.

Long-term nursing facilities across the United States have responded to the Delta outbreak by mandating vaccines or even firing workers who don’t get their shots. In some places, staff have also resigned in protest of the requirement.

“The Delta variant is so contagious that you have outbreaks in healthcare facilities that are driven by non-vaccinated workers, but then spreads to vulnerable patients as well,” says David Lazer, university distinguished professor of political science and computer sciences at Northeastern, and one of the researchers who conducted the study.

“In places where you have lots of healthcare workers who are not vaccinated and there haven’t been mandates, it’s going to be like lots of tightly-packed dominoes where you knock one over and it’s going to create these big waves of infections,” he explains.

Texas, for example, doesn’t require nursing home residents or staff to be vaccinated. The number of nursing homes across the state with at least one active COVID-19 case increased nearly 800 percent in the past month. Nearly half of nursing home employees in Texas remain unvaccinated.

Massachusetts, meanwhile, requires all staff in long-term care facilities to be fully vaccinated by Oct. 10. The mandate marked Gov. Charlie Baker’s first order to require vaccination in any private or public workforce.