The new policy makes San Francisco the first city or county in California — and probably the U.S. — to mandate COVID vaccinations for all government employees.
San Francisco previously announced that it will require employees to be vaccinated in high-risk settings, including hospitals, nursing homes and jails, regardless of whether they work for the city. The new policy will mandate vaccinations for all city employees, from police and firefighters to Muni operators and City Hall clerks and custodians. It does not cover teachers, who are school district employees.
City workers who refuse to be vaccinated and don't get a medical or religious exemption could be fired.
Employees will have 10 weeks after a vaccine is approved by the FDA to get their shots. The three vaccines used in the United States currently are under emergency authorization by the FDA, but they are expected to be fully approved within a few months.
Starting Monday, employees will have 30 days to report to the city their current vaccination status, including showing proof of vaccination. As of Wednesday, about 55% of city employees have said they are at least partially vaccinated, according to the Department of Human Resources . About 5% of employees have said they are not vaccinated. The vaccination status of the remaining 40% is not known.
"It's really a decision for the health and safety of our employees and our public that we serve," said Carol Isen , San Francisco director of human resources. "It's about protecting the city as an employer from what we deem to be unacceptable risk."
Employees will report their vaccination status through the city's payroll system, Isen said. They must provide proof by uploading a photo of their vaccination card or the QR code generated by the state's digital verification system.
Mawuli Tugbenyoh, chief of policy for the Department of Human Resources , said that "repercussions (for refusing vaccination) go all the way up to termination. But we're focused on the education and outreach part of it now."
San Francisco has among the highest vaccination rates in the state, with about 80% of residents 12 and older who are eligible for vaccines having received at least one dose. But about 60% of city employees live elsewhere in the Bay Area, where vaccination rates may be lower, Tugbenyoh said.
The city is the second-largest employer in San Francisco after UCSF. Although San Francisco appears to be the first city or county in the U.S. to mandate vaccinations for its employees, institutions like hospitals, universities and nursing homes have announced similar policies. Most, like San Francisco , are requiring vaccination only after the vaccines are formally approved.
A health care system in Texas caused an uproar among its staff in April when it required all workers to be vaccinated ahead of FDA approval. This week, about 150 staff members were fired or quit after refusing to be vaccinated.
Tugbenyoh said he was aware of the fallout in Texas and expected some San Francisco employees to have reservations about a mandate.
"But we're saying only after the FDA approves it," he said.
He noted that San Francisco would allow exemptions for medical or religious reasons.
Officials with several San Francisco city workers unions said Wednesday that they had only just heard of the vaccine mandate and did not yet have a comment. But Tracy McCray , vice president of the San Francisco Police Officers Association , said that "we appreciate that the city's mandate goes into effect after full FDA approval and that they have provided the appropriate medical and religious exemptions for those city employees who need them."
Isen said she hoped to work with unions to encourage employees to get vaccinated ahead of the mandate.
"We want to do everything we can to help our employees get over whatever hurdles, physical or emotional or psychological, that they're having to getting vaccinated," she said.
Vaccine mandates are important for protecting public health, especially for people who work in high-risk settings, said Arthur Caplan , a bioethicist at New York University's Grossman School of Medicine . For example, flu vaccine mandates are common among health care workers and nursing home staffers, even those who don't work directly with residents.
Mandates may also be key for keeping critical workforces — like police and firefighters — healthy and intact. In some parts of the country, vaccine uptake has been notably low among emergency workers. That puts the people they come into contact with at risk and could be devastating if an outbreak meant many workers were too sick to do their jobs, Caplan said.
Dr. Grant Colfax , director of the San Francisco Department of Public Health , said protecting the workforce was especially important with the highly infectious delta variant gaining traction across the United States . Although he's pleased that 80% of San Francisco residents are at least partially vaccinated, "the fact is there are still thousands who are not vaccinated," he said.
"Given that the delta variant is here and likely to increase in terms of its prevalence across the city, we need to do everything we can to protect our city workforce and the public we serve, especially as the city reopens," Colfax said. "The last thing we want to do is have to slow or curtail city services because of an increase in cases."
Once the FDA approves the vaccines, Caplan said, "You're going to see more hospitals, nursing homes, home care programs move to mandate. Followed pretty quickly by the military, then some private employers and people with big overseas sales forces. And then maybe some local governments.
"But I don't think county or city governments are going to be first in line, even if San Francisco was the first to do it," he added.
Colfax said he hoped that other cities or counties would join San Francisco .
"It's not the first time in the pandemic that ( San Francisco ) has continued to push ahead, push things forward," he said. "We think from the broader public health lens that this is absolutely important and the right thing to do."
Erin Allday is a San Francisco Chronicle staff writer. Email: eallday@sfchronicle.com Twitter: @erinallday
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