What COVID boosters mean for California’s health care worker vaccination mandate

The FDA on Wednesday authorized boosters for health care workers because of the higher risk of exposure they face on the job. Then on Thursday, the CDC’s vaccine advisory panel disagreed, voting against recommending boosters to adults under 65 who face higher risk of infection or transmission at work — including health care workers. Just hours later, CDC Director Dr. Rochelle Walensky announced that the agency is in fact recommending boosters for health care workers. The CDC almost never overrules its advisory panel.

In a statement Friday, Gov. Gavin Newsom said California will begin providing boosters to eligible groups right away.

“Vaccines are how we end this pandemic,” Newsom said. “Vaccines save lives, and boosters are a critical next step towards better protecting Californians from COVID-19.”

For now, boosters are limited to Pfizer recipients who got their second dose at least six months ago. Pfizer is the only vaccine manufacturer so far to receive federal authorization for a third dose. Moderna this month applied for FDA authorization for a booster shot, but regulators have not yet authorized it. Johnson & Johnson has not yet applied, though the company shared data this week showing a second dose boosts protection.

The decision to approve boosters for health care workers could move the vaccination goalpoast for California’s doctors, nurses and other providers, who are already under one of the strictest vaccination requirements in the country.

Under a state order announced by Newsom last month, all California health care workers must be fully vaccinated by Sept. 30. Unlike many other states, California does not give health care workers the option to “test out” of the vaccine requirement by getting tested once or twice a week, unless they get a medical or religious exemption.

It is unclear whether California will now require health care workers to get a booster in order to be considered fully vaccinated and, if so, whether it would extend the deadline past Sept. 30. Walensky on Friday signaled that boosters are recommended but not required, saying that the CDC is not changing its definition of “fully vaccinated” right now. The CDC considers someone fully vaccinated 14 days after the second dose of Pfizer or Moderna or the first dose of Johnson & Johnson.

“We are preparing and considering what it would mean for 2.5 million health care workers in California and looking at how it impacts the requirements we have for so many of those individuals to be vaccinated,” Dr. Mark Ghaly, the California Health and Human Services secretary, on Thursday, said before the CDC recommendations came out.

When asked Friday whether the state will require health care workers to get a third dose, now that the CDC has advised boosters for them, a spokeswoman for Health and Human Services referred to the governor’s written statement. The statement did not address whether boosters would be required.

Large studies on vaccine efficacy have shown that health care workers who are vaccinated remain generally well protected against COVID. One study of about 4,200 frontline workers and health care personnel from December to August found that the vaccines were 73% protective against symptomatic infection about five months out.

Federal authorities said they included health care employees among those recommended for boosters in part to protect a workforce that’s been strained nationwide during the pandemic. Several studies in the U.S. and Israel have found signs of waning protection over time, though the vaccines hold up well at preventing severe illness. But even mild disease can force someone out of work for a week or longer.

“Most of these health care workers actually have pretty good immunity, so I think it’s really hard to tie their employment to a third shot or a booster at this time,” said Sonoma County Health Officer Dr. Sundari Mase. “I also don’t see it as being a big problem. Many people who got the first two doses are clamoring to get a booster of anything. We’ll see how that plays out.”

As California’s Sept. 30 deadline nears, it’s not clear whether the vaccination mandate has improved uptake among health care workers. The California Department of Public Health collects vaccination rates only for nursing home staff, so the rates in other health care settings — including hospitals and a wide variety of outpatient clinics — are not known across the state.

In the Bay Area, three of the region’s largest providers — Sutter, UCSF and Stanford — say 95% or more of their workers are fully vaccinated. A fourth, Kaiser, says 90% of its employees and 97% of its physicians are vaccinated.

Very few workers — 3% or less, according to Stanford and UCSF — have sought or gotten religious or medical exemptions. All four providers required their health care workforce to get vaccinated even before the state mandate was announced.

The state order does not spell out consequences or enforcement mechanisms for health care workers who do not get vaccinated and who do not get a religious or medical exemption.

A Stanford spokesperson said they are prepared to place unvaccinated health care workers on unpaid administrative leave until they get vaccinated. Similarly, Kaiser said it could put such workers on unpaid administrative leave starting Oct. 1, and if they are still not vaccinated by Dec. 2, they could be terminated.

“Our goal is not to end anyone’s employment,” said Kaiser spokesman Karl Sonkin. “It’s to ensure that our workforce, patients, and communities are safe as possible from the virus.”