California First in Nation to Mandate COVID-19 Vaccinations for All Health Care Workers

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Registered nurses Angelo Daulat and Amy Fulgado at Kaiser Permanente in Richmond in the early days of the pandemic on March 19, 2020. (Beth LaBerge/KQED)

California is the first state in the nation to require all of its roughly 2.2 million health care and long-term care workers to be fully vaccinated against the coronavirus.

The new order, issued Thursday by the California Department of Public Health, mandates all that all health care workers must be fully vaccinated by the end of Sept. 30 — allowing only for religious or rare medical exemptions.

The order tightens Gov. Gavin Newsom’s move last week to require health care workers and state employees to be vaccinated or submit to weekly testing. Now, there is no longer a choice.

The change comes as California is seeing the fastest increase in new virus cases since the start of the pandemic, averaging 18.3 new cases per 100,000 people a day. Most of the state's new infections are caused by the delta variant, a more contagious version of the coronavirus that the state says “may cause more severe illness.”

More than 5,500 Californians are currently hospitalized for COVID-19, with about one-fifth of them needing intensive care.


“Increasing numbers of health care workers are among the new positive cases, despite vaccinations being prioritized for this group when vaccines initially became available,” said Dr. Tomás J. Aragón, California's public health officer.

The order represents a new hard line in public health leaders' quest to convince the hesitant to receive the vaccine. Several states are focusing on health care workers, since they are around vulnerable patients.

“As we continue to see an increase in cases and hospitalizations due to the delta variant of COVID-19, it’s important that we protect the vulnerable patients in these settings,” Aragón said in a statement. “Today’s action will also ensure that health care workers themselves are protected. Vaccines are how we end this pandemic.”

But other states with similar requirements have carved out exceptions, like in Oregon, where health care workers can instead get regular COVID-19 testing. In Maryland, the vaccine mandate only applies to certain state employees, such as those who work in health care facilities under the state health department.

In California, vaccine mandates are politically perilous for Newsom, who is facing a recall election next month fueled in part by anger over his handling of the pandemic. Newsom has angered many parents by continuing to require masks indoors at all public schools, although he has not required all teachers and staff to be vaccinated.

Some California local governments are going beyond the new rule. In June, San Francisco became the first major U.S. city to announce it would require all 36,000 of its city employees to be fully inoculated against the virus — or risk losing their jobs— once the vaccines receive full approval from the U.S. Food and Drug Administration.

And in Los Angeles County, some 110,000 government workers have until Oct. 1 to be vaccinated under a new order issued by Board of Supervisors Chair Hilda L. Solis.

She noted that about 4 million of the county’s roughly 10 million residents remain unvaccinated. The Los Angeles order doesn’t specify penalties for employees who refuse to be vaccinated.

Meanwhile, a letter to the approximately 5,000 staffers of Los Angeles County Superior Court — the nation's largest trial court system — ordered them to be fully vaccinated or be fired. The letter says workers must show proof of vaccination no more than 45 days after the federal Food and Drug Administration gives its final approval to one of the vaccines available in the U.S., the Los Angeles Times reported.

Both of those mandates provide exceptions for people for medical or religious reasons.

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California's new vaccine mandate is broad and applies to workers in most health care facilities, including hospitals, skilled nursing facilities, psychiatric hospitals, adult day health care centers, dialysis centers, hospice facilities and clinics and doctor's offices.

A second public health order directs facilities to verify that visitors are fully vaccinated or have tested negative for COVID-19 in the last 72 hours before indoor visits.

The state said it would give its updated guidance for long-term care facilities “in the near future.”

Carmela Coyle, president and CEO of the California Hospital Association, called the vaccine mandate “an important step in the long battle we face against COVID-19 and the multiple variants that have emerged.”

“We are once again on a dangerous precipice that demands both our fortitude and our goodwill to protect loved ones and neighbors,” Coyle said. “California’s health care workers are being called upon — as they have through every step of this pandemic — to lead the charge in the battle between vaccine and variant.”

About 63% of Californians 12 and older have been fully vaccinated. Another 10% have been partially vaccinated.

COVID-19 vaccines are free. Unvaccinated Californians age 12 and up can go to or call (833) 422-4255 to schedule an appointment or go to to find a walk-in clinic in their county.