ROCHESTER, Minn. All Mayo Clinic employees must be vaccinated for COVID-19, or undergo added training and agree to special mitigation protocols that include social distancing and masking while on campus.

The clinic has set Sept. 17 as the cutoff date for all employees to either have become vaccinated or undergo what it termed a "declination" process. Declination is a word meaning "refusal."

"We are proud of our staff's high vaccination rates and are grateful that the vast majority have embraced the opportunity to get vaccinated," said Mayo Clinic President and CEO Dr. Gianrico Farrugia in a statement Monday, July 26. "Our patients expect to be safe when they come to Mayo Clinic, and we need to do everything we can to protect everybody."

There will be religious and other exemptions, according to Mayo spokesperson Ginger Plumbo, details of which will be provided on a declination form available to employees on Aug. 23.

Staff who decline to be vaccinated for COVID-19 "must complete education modules and will be required to wear masks and socially distance when on campus," the statement read.

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“Education modules will include answers to some of the typical questions about COVID-19 vaccinations," said Dr. John O'Horo. "Education will also include instruction on appropriate masking and distancing practices and strategies for the unvaccinated to stay as safe as possible.”

Plumbo said 95% of its doctors and 75 to 85% of Mayo staff are vaccinated for COVID-19.

WIth 34,000 employees at Mayo Clinic Rochester, that means as many as 8,500 local employees will need to decide whether to get the shots or adopt new restrictions accompanying declination status.

Plumbo said they will entail two required videos followed by comprehension quizzes.

The announcement comes five days after Sioux Falls-based Sanford Health became the first hospital in the region to mandate vaccination for employees beginning Nov. 1. While the Sanford policy gives holdouts longer to comply than has Mayo, it takes a harder line on the price for going unvaccinated, with those who do not become vaccinated for COVID-19 risking the loss of their jobs.

"It will be a condition of employment at Sanford Health," chief physician Dr. Jeremy Cauwels told reporters last week. "If you don’t have a religious exemption or otherwise, we will be requiring it to work at Sanford."

Nationally, Houston Methodist was the first major hospital in the United States to require vaccination for COVID-19 from its employees, a step it took nearly four months ago. After enacting the policy April 1, then surviving a court challenge, the medical center subsequently dismissed or accepted the resignations of 153 workers who refused to comply.

Since then, dozens of hospitals from across the country have enacted similar policies, including Dana-Farber Cancer Institute, Henry Ford Health System, Mass General, Duke, the University of Chicago, Mercy St. Louis and the UC system.

Vaccination has become a subject of intense focus for health officials from across the U.S. as the vastly more transmissible delta variant becomes predominant and as data reveal that nearly everyone being treated in the hospital for COVID-19 has been unvaccinated.

Schools have required vaccination for enrollment since the beginning of the 20th century and all states have had laws requiring vaccination to attend school since the early 1980s.

Calling it "the logical fulfillment of the ethical commitment of all health care workers to put patients ... first," a coalition of 56 medical specialties recently issued a joint statement calling for mandatory vaccination within health care.

That coalition included the American Medical Association, the American College of Physicians, the American Nurses Association and the American Academy of Pediatrics.

The participation of those societies suggest that health care workers who oppose a COVID-19 vaccination mandate may find it challenging to enlist academic leadership in support of their cause.

Traditionally, unions have supported vaccination for health care workers but opposed mandates as a condition of employment.