​Related Materials: State and Local Correctional Facilities and Detention Centers Health Care Worker Vaccination Requirement Q&A 

State Public Health Officer Order of March 3, 2023

Since the start of the pandemic, the California Department of Public Health (CDPH) has led with science and data to better understand COVID-19. California has seen a dramatic increase in the percentage of Californians that are fully vaccinated and boosted. At present, 80% of Californians 12 years of age and older have completed their primary series of COVID-19 vaccines, and 62% have also received at least their first booster dose. Vaccine coverage is also high among workers in high-risk settings, and the proportion of unvaccinated workers is low.

On December 22, 2021, this Order was amended to make boosters mandatory for covered workers and to require additional testing of workers eligible for boosters who are not yet boosted.  Between that time and the March 1^st, 2022, deadline, booster rates for healthcare personnel increased 47%.  Since March 2022, healthcare personnel booster rates reached 90%.  In addition, 88% of Skilled Nursing Facility healthcare personnel have received at least one booster dose and 71% of staff at the California Department of Corrections and Rehabilitation have completed their primary series.

In addition, at the federal level, QSO-23-02-ALL (Revised Guidance for Staff Vaccination Requirements) currently requires all Medicare- and Medicaid-certified providers ensure that all applicable staff are vaccinated with COVID–19 primary series.  Federal regulations 42 CFR 483.80(d)(3) and 42 CFR 483.460(a)(4)(i) also require that Long-Term Care (LTC) facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs-IID) must offer COVID-19 vaccines to residents, clients, and staff onsite when supplies are available to the facility and in accordance with the CDC and the Advisory Committee on Immunization Practices (ACIP) COVID-19 vaccine schedule, which includes bivalent booster doses.

In March 2022, California announced the release of the state's SMARTER Plan,  the next phase of California's COVID-19 response. California's path forward will be predicated on individual, smarter actions that will collectively yield better outcomes for our neighborhoods, communities, and state. Healthcare personnel staying up to date with COVID-19 vaccinations and boosters remains the most important strategy to prevent serious illness and death from COVID-19.

Consequently, although COVID-19 remains with us, I am rescinding the August 19, 2021 State Public Health Officer Order effective April 3, 2023.​​​

Introduction from State Public Health Officer Order of September 13, 2022

Since the start of the pandemic, the California Department of Public Health (CDPH) has led with science and data to better understand this disease. California has seen a dramatic increase in the percentage of Californians that are fully vaccinated and boosted.  At present 80% of Californians 12 years of age and older have completed their primary series of COVID-19 vaccines, and 48% have received their first booster dose. Vaccines for children 5-11 years of age have been available since October 2021.  Vaccine coverage is also high among workers in high-risk settings, and the proportion of unvaccinated workers is low.  As we've also seen, the Omicron subvariants have shown immune escape and increased transmissibility, and while unvaccinated individuals still have higher risk of infection, previously infected, vaccinated, and boosted persons have also been infected. Consequently, mandated testing of the small number of unvaccinated workers is not effectively preventing disease transmission as it did with the original COVID-19 virus and prior variants earlier in the pandemic. 

On August 11th and August 24th, the Centers for Disease Control (CDC), in updated guidance, also indicated that screening testing is no longer recommended in general community settings, and while screening testing may still be considered in high-risk settings, if implemented it should include all persons, irrespective of vaccination status, given recent variants and subvariants with significant immune evasion.

COVID-19 vaccination and boosters continue to remain the most important strategy to prevent serious illness and death from COVID-19. 

Accordingly, amendments to the State Public Health Officer Order of February 22, 2022 regarding required testing for exempt covered workers are needed at this time, to reflect recent CDC recommendations, the current science of the Omicron subvariants, the increases in community immunity from vaccination and infection, and increases in vaccine coverage of our healthcare workforce. 

Covered workers must continue to comply with all required primary series and vaccine booster doses pursuant to Table A below. The timing of required booster doses has been amended to reflect current CDC recommendations.  Additionally, facilities must continue to track workers' vaccination or exemption status to ensure they are complying with these requirements.  CDPH recommends that all workers stay up to date on COVID-19 and other vaccinations. 

CDPH continues to assess conditions on an ongoing basis. California must be vigilant to maintain situational awareness through surveillance and be ready to pause or reinstate a higher level of protective mitigation recommendations or requirements.

Introduction from Original State Public Health Officer Order of February 22, 2022

Since the start of the pandemic, CDPH has led with science and data to better understand this disease.  There has been a growing body of evidence suggesting that a combination of history of SarsCoV2 vaccination and infection can lead to a strong "hybrid" immunity after recovery from infection.  Additionally, there is immunological data suggesting that allowing an adequate interval between an infection and a COVID-19 vaccination dose may be important to allow quality immune memory.  

Vaccines continue to remain the most critical aspect of moving our communities out of this pandemic.  They lower risk of getting and spreading the virus that causes COVID-19 and also prevent serious illness and death.  They are critical for building a foundation of individual and herd immunity, especially while a portion of our population continues to be unvaccinated.  According to the CDC "… getting a COVID-19 vaccination is a safer and more dependable way to build immunity to COVID-19 than getting sick with COVID-19. COVID-19 vaccination causes a more predictable immune response than infection with the virus that causes COVID-19."  Conversely, the level of protection people get from COVID-19 infection alone may vary widely depending on how mild or severe their illness was, the time since their infection, which variant they were infected with, and their age.  Increasing evidence shows that a combination of infection after completing the primary series of vaccination can build strong hybrid immunity.

Thus CDPH is updating its order requiring health care workers to be fully vaccinated and boosted by March 1, 2022 to allow delay of the March 1, 2022 deadline for receiving a booster for covered workers with proof of a recent infection for up to 90 days from date of infection. Accordingly, amendments to the original State Public Health Officer Order of December 22, 2021, are needed at this time, to reflect current science and understanding as it relates to hybrid immunity in those who are fully vaccinated and then become infected. As we continue to learn more about post-Omicron infection immunity, hybrid immunity, waning immunity in general, and what new variants may evolve, we will continue to reassess COVID-19 vaccine requirements and recommendations. 

Introduction from Original State Public Health Officer Order of December 22, 2021 

Since Thanksgiving, the statewide seven-day average case rate has increased by 34% and hospitalizations have increased by 17%. In addition, the recent emergence of the Omicron variant (it is estimated that approximately 70% of cases sequenced, nationally, are Omicron and rapid increases are occurring globally) further emphasizes the importance of vaccination, boosters, and prevention efforts, including testing, which are needed to continue protecting against COVID-19.  

Early data also suggest the increased transmissibility of the Omicron variant is two to four times as infectious as the Delta variant, and there is evidence of immune evasion. Recent evidence also shows that among healthcare workers, vaccine effectiveness against COVID-19 infection is also decreasing over time without boosters.  Consequently, current vaccine requirements of staff in health care settings are not proving sufficient to prevent transmission of the more transmissible Omicron variant.  Boosters have been available in California since September 2021. 

Although COVID-19 vaccination remains effective in preventing severe disease, recent data suggest vaccination becomes less effective over time at preventing infection or milder illness with symptoms, especially in people aged 65 years and older. 

Based on the emergence of Omicron, additional statewide facility-directed measures are necessary to ensure we maintain adequate staffing levels within our healthcare delivery system.  Additionally, given the current hospital census, even a moderate surge in cases and hospitalizations could materially impact California's health care delivery system within certain regions of the state.  Accordingly, amendments to the original State Public Health Officer Order of August 19, 2021, to make boosters mandatory and to require additional testing of workers eligible for boosters who are not yet boosted are necessary at this critical time.   

NOW, THEREFORE, I, as State Public Health Officer of the State of California, order: 

1. All individuals in section (2) below must have their first dose of a one-dose regimen or their second dose of a two-dose regimen by October 14, 2021:

a. Two-dose vaccines include: Pfizer-BioNTech, Moderna or Novavax or vaccines authorized by the World Health Organization.  The one-dose vaccine is: Johnson and Johnson [J&J]/Janssen. All COVID-19 vaccines that are currently authorized for emergency use can be found at the following links: 

i. By the US Food and Drug Administration (FDA), are listed at the FDA COVID-19 Vaccines webpage. 

ii. By the World Health Organization (WHO), are listed at the WHO COVID-19 Vaccines webpage.

2. The following workers are subject to the requirements of this Order:

a. All paid and unpaid individuals who are regularly assigned to provide health care or health care services to inmates, prisoners, or detainees. This may include nurses, nursing assistants, nurse practitioners, physicians, physician assistants, technicians, therapists, phlebotomists, pharmacists, mental health providers, students and trainees, dietary, and contractual staff not employed by the correctional facility or detention center. 

b. All paid and unpaid individuals who are regularly assigned to work within hospitals, skilled nursing facilities, intermediate care facilities, or the equivalent that are integrated into the correctional facility or detention center in areas where health care is provided. This includes workers providing health care to inmates, prisoners, and detainees, as well as persons not directly involved in delivering health care, but who could be exposed to infectious agents that can be transmitted in the health care setting (e.g., clerical, dietary, janitorial services, laundry, correctional officers, facilities maintenance staff, administrative, inmate workers, and volunteer personnel). 

3. All workers currently eligible for boosters, who provide services or work in facilities described in section (2) must be "fully vaccinated and boosted" for COVID-19 by receiving all recommended doses of the primary series of vaccines and a vaccine booster dose pursuant to Table A below.

Table A: 
California Immunization Requirements for Covered Workers 

a. Those workers currently eligible for booster doses per the Table above must receive their booster dose by no later than March 1, 2022.[i] Workers who provide proof of COVID-19 infection after completion of their primary series [ii] may defer booster administration for up to 90 days from date of first positive test or clinical diagnosis, which in some situations, may extend the booster dose requirement beyond March 1st.  Workers not yet eligible for boosters must be in compliance no later than 15 days after the recommended timeframe above for receiving the booster dose. Workers with a deferral due to a proven COVID-19 infection must be in compliance no later than 15 days after the expiration of their deferral. 

4. Workers in section (2) may be exempt from the vaccination requirements under section (1) only upon providing the operator of the correctional facility or detention center a declination form, signed by the individual stating either of the following: (1) the worker is declining vaccination based on religious beliefs, or (2) the worker is excused from receiving any COVID-19 vaccine due to Qualifying Medical Reasons.

a. Integrated skilled nursing facilities must continue to comply with current federal requirements that may require more stringent testing of staff, including QSO-20-38-NH REVISED (cms.gov) “Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements" or similar requirements that may be imposed in the future.