On December 22, the California Department of Public Health issued an order that requires health care workers working at certain facilities to be fully vaccinated against COVID-19 and to receive boosters by February 1 unless an exemption applies. Workers who are not yet eligible for a booster must comply no later than 15 days after the CDPH’s recommended timeframe (see Table, below) for receiving the booster. In addition, while waiting, workers in acute care and long term care settings who are eligible for boosters but have not yet received them must undergo COVID testing twice a week.
The December 22 order supersedes an order issued August 5. The prior order, summarized here, required most health care workers to be fully vaccinated (either both shots of a two-shot vaccine or one shot of a single-shot vaccine) by September 30, 2021.
The CDPH provides the following table as the recommended timeframe for workers to obtain the booster:
California Immunization Requirements for Covered Workers
| COVID-19 Vaccine | Primary vaccination series | When to get the vaccine booster dose | Which vaccine booster dose to receive |
| Moderna or Pfizer-BioNTech | 1st and 2nd doses | Booster dose 6 mos after 2nd dose | Any of the COVID-19 vaccines authorized in the United States may be used for the booster dose, but either Moderna or Pfizer-BioNTech are preferred. |
| Johnson and Johnson [J&J]/Janssen | 1st dose | Booster dose 2 mos after 1st dose | Any of the COVID-19 vaccines authorized in the United States may be used for the booster dose, but either Moderna or Pfizer-BioNTech are preferred. |
| World Health Organization emergency use listing COVID-19 vaccine | All recommended doses | Booster dose 6 mos after getting all recommended doses | Single booster dose of Pfizer-BioNTech COVID-19 vaccine |
| A combination of FDA-approved, FDA-authorized, or WHO-emergency use listing COVID-19 vaccines | All recommended doses | Booster dose 6 mos after getting all recommended doses | Single booster dose of Pfizer-BioNTech COVID-19 vaccine |
Apart from the booster requirement, the December 22 order is substantially similar to the August order.
The CDPH further encourages covered health care facilities to provide onsite vaccinations, easy access to nearby vaccinations, use of work time to get vaccinated, and education about vaccination.
It is unclear how the CDPH plans to enforce noncompliance with the December 22 order. Covered health care facilities should also be aware of applicable local rules because some counties and cities have their own booster mandates. For example, a Booster Health Order issued by Santa Clara County says that noncompliance will “[constitute] a public nuisance, and is punishable by fine, imprisonment, or both” and is also “subject to the civil enforcement authority.”
What should covered health care facilities do?
In addition to enforcing the older vaccine mandate and testing requirements for exempt and non-exempt workers (including any contracted staff), and verifying and maintaining vaccination and testing records per the CDPH’s guidelines, covered health care facilities will now need to administer this “booster mandate.” The booster mandate has no new policy or procedure requirements, but covered health care facilities should consider adding the booster requirement to their policies and procedures anyway, to ensure that employees are aware of the new requirement and to ensure consistency. And, again, health care employers must ensure that they are up to date on any local vaccination requirements that are stricter than the state requirement.
Covered health care facilities should also consider the following:
- Whether the December 22 order requires health care workers at covered facilities to get additional COVID boosters as they are approved.
- What to do if operating in multiple locations with different local requirements.
- How to pay for the boosters. For the most part, COVID vaccinations and testing are generally covered by the health care worker’s health insurance. If not, then the health care facility may consider covering the cost directly, or referring workers to free local vaccination and testing sites such as https://myturn.ca.gov/.
We are happy to answer any questions that you may have or provide further assistance to ensure compliance with or addressing noncompliance with the new “booster mandate.”
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