The following list of frequently asked questions relate to a February 10, 2022 health order, which was updated and amended on April 14, 2022, requiring COVID-19 vaccinations for certain law enforcement, fire and emergency medical services personnel who work in higher-risk settings. For more information, please review the health order, accompanying news release, or recent town hall presentation.
Q: Is this Order lawful?
A: Yes, this Order was lawfully issued.
Health Officers are mandated to provide communicable disease control, including the control of acute communicable diseases, based upon provision of appropriate preventive measures for communicable disease hazards in the community (17 C.C.R. § 1276(c)). Under Health and Safety Code Section 120175, the local health officer may take measures as may be necessary to prevent and control the spread of disease within the territory under their jurisdiction.
Additionally, under Health and Safety Code Section 101040, the local health officer may take “any preventative measure that may be necessary to protect and preserve the public health from any public health hazard” during a state of emergency or local emergency, including mandate vaccines. The United States Supreme Court recently upheld the U.S. Secretary of Health and Human Services’ authority to mandate COVID-19 vaccinations for all personnel working in Medicaid- or Medicare-funded healthcare facilities. Issuing a similar requirement for all first responders who routinely enter higher-risk settings aligns with state and federal law. Other Bay Area jurisdictions, including the City and County of San Francisco and the County of Santa Clara, have issued similar orders.
Q: Why did Public Health issue this order now?
A: Although the Omicron wave is receding, Public Health is concerned about future variants. Global models forecast emerging variants, epidemic waves (potentially as early as this summer), and intensified Omicron transmission in the fall. While the County is highly vaccinated, we are experiencing a global pandemic. Currently, only 55% of the global population is vaccinated; and only 11% of people in low-income countries have received at least one dose. The two variants that have had the greatest effect on our County, Delta and Omicron, emerged in other countries, India and South Africa, respectively.
Optimizing booster coverage among healthcare personnel and first responders is critical for public health and safety preparedness against another COVID wave caused by a variant with unknown characteristics. There are significantly higher rates of COVID transmission in unboosted, fully vaccinated persons more than 6 months from completing their primary vaccine series. Vaccine-induced and infection-induced immunity wane considerably after 6 months. The majority of vaccinated first responders and healthcare personnel in Marin County completed their primary vaccine series more than one year ago as they were prioritized as Tier 1a vaccine recipients (January 2021).
During the Omicron wave, some first responder agencies experienced critical staffing shortages. The County also had a shortage of testing resources, making it difficult for unvaccinated first responders to comply with testing requirements. The testing cadence proved insufficient to prevent staff-to-staff transmission. Furthermore, relaxation of COVID mitigation strategies among the general public will increase the risk of occupational exposure to COVID-19.
Ensuring that all first responders and healthcare personnel who work in higher-risk settings or who regularly interact with the public are both vaccinated and boosted when eligible is critical given the risk that health systems can become overwhelmed by future variants. First responders (1) can expose other staff to vaccine-preventable illness, (2) can expose highly vulnerable individuals who are at increased risk of severe illness and death, (3) must be protected from COVID-19 to the maximum extent possible to ensure adequate staffing in these critical settings, and (4) in the case of jails, shelters, and skilled nursing facilities, infected staff can be part of the chain of transmission in large outbreaks.
Q: Why is this Order requiring first responders complete their primary vaccination series and recommending they receive a booster when eligible?
A: Ensuring that first responders and healthcare personnel who work in higher-risk settings or regularly interact with the public are both vaccinated and boosted when eligible is critical given the ongoing risk of COVID-19 transmission, including medical surge and large outbreaks. Individuals working in these settings (1) can expose other staff to vaccine-preventable illness, (2) can expose highly vulnerable individuals who are at increased risk of severe illness and death, (3) must be protected from COVID-19 to the maximum extent possible to ensure adequate staffing in these critical settings, and (4) in the case of jails, shelters, and skilled nursing facilities, infected staff can be part of the chain of transmission in large outbreaks.
Q: Are there other local vaccine mandates for first responders and healthcare personnel?
A: Yes. In 2012, Marin County Public Health issued the first Health Officer order requiring influenza vaccination or masking for healthcare personnel. In 2015, this order was expanded to include emergency medical services (EMS) personnel. In 2017, this order was expanded to include correctional facilities. In 2020, the order removed the masking option. In 2021, the order was expanded to require mandatory influenza vaccination for all staff at health care and congregate facilities.
Q: Are there other COVID-19 vaccine mandates?
A: Yes, this Order builds on the State Health Officer’s vaccination mandates—which were updated to include a booster requirement on December 22, 2021—for workers in the healthcare sector, in correctional healthcare, and in adult care. The February 22, 2022, update aligns with Marin County’s recognition of natural immunity and allows for workers with completed primary series vaccination and recent infection to defer booster dose by up to 90 days from infection.
All persons and entities must comply with both State and local Orders.
Q: Are there exemptions to the Order’s requirements?
A: Yes, individuals covered by the Order may be exempt from the vaccination requirement based on a medical or religious exemption. Employers should undertake a good faith, individualized exemption process. Nothing in this Order is intended to limit an employer’s ability under applicable law to determine whether to grant an employee’s request for such an exemption, consistent with all applicable laws, and to offer an appropriate reasonable accommodation. Please note that Marin County Public Health is not responsible for determining whether an individual qualifies for an exemption; rather, that is a determination made by the individual’s employer.
Q: Why is the Marin County COVID-19 vaccine mandate narrower than Santa Clara’s and San Francisco’s vaccine mandates, which include all workers in higher-risk settings?
A: Marin County Public Health is taking a measured approach with the COVID-19 vaccine mandate focusing on the persons with the highest occupational risk for exposure and the highest contact with vulnerable persons.
At this time, Public Health strongly urges all persons who work in higher-risk settings to stay up to date and get boosted as soon as booster eligible. Marin County Public Health will monitor local COVID-19 community levels and determine if and when the vaccine mandate should be expanded to include all staff who work in Marin’s higher-risk settings.
Q: Why mandate vaccines instead of requiring more frequent COVID-19 testing?
A: Public Health issued an order on September 1, 2021, requiring first responders to show proof of vaccination or undergo weekly COVID-19 surveillance testing. The testing cadence proved insufficient to prevent staff-to-staff transmission. Despite the September 1, 2021 Order, booster rates among first responders have lagged behind that of the general public. During the Omicron surge, first responders experienced critical staffing shortages due to Omicron illness and quarantine.
Vaccination remains a safe and effective means of preventing COVID-19 and its associated harms. Individuals who have not received a booster shot are more likely to become infected and spread infection to others and are more likely to become seriously ill and die. Requiring vaccination for first responders and healthcare personnel who work in higher-risk settings is important to reduce risk of transmission in these settings, protect vulnerable populations, and ensure sufficient staffing.
Q: Why not mandate vaccines for incarcerated persons in the county jail?
A: Marin County Jail has isolation and quarantine requirements for inmates. All new inmates are placed in quarantine directly from booking for 10 days. They are tested on day 5 or later with antigen and molecular tests. If they test positive, they are placed in isolation. If they test negative, they can enter the general population after day 10. If untested, inmates may not enter the general population sooner than day 11 (vaccinated, untested) or day 15 (unvaccinated, untested). COVID-19 vaccines and boosters are offered to all inmates.
Q: Why not mandate COVID-19 vaccines for all eligible Marin residents?
A: Marin County Public Health strongly urges all eligible residents to get vaccinated and stay up to date. Marin County Public Health is taking a measured approach with the COVID-19 vaccine mandate focusing on the persons with the highest occupational risk for exposure and the highest contact with vulnerable persons.
Q: Can staff decline to complete their primary COVID vaccination series?
A: No. Under the order, staff cannot decline completion of their primary series COVID vaccination. If eligible, they may request a medical or religious exemption.
Q: What happens if staff are not vaccinated on March 1st?
A: Employers and supervisors should counsel staff on the importance of COVID-19 vaccine and boosters and the importance of following Health Officer orders and public health guidance to prevent the spread of communicable diseases, including flu and COVID-19. Individuals covered by the Order are required to receive their first dose of the COVID-19 vaccine or their booster shot, if eligible, by March 1. Individuals who had a confirmed COVID-19 infection prior to February 9, 2022, may have additional time to obtain their vaccine or booster. Effective April 15, any individuals who are not in compliance with the Order will no longer be able to enter higher-risk settings or interact with the public while at work. Supervisors are expected to counsel non-compliant staff on the legal support for mandatory vaccines and to work with individual staff to plan adherence no later than April 15th.
Q: What happens if staff are not compliant with the Order on April 15th and do not have a qualified exemption?
A: Effective April 15, 2022, all Law Enforcement, Fire, and EMS Personnel who are not Fully Vaccinated or not up to date, except as provided in Section 3.e, cannot entering Higher-Risk Settings or interact with the public in the course of their work.
Q: Are vaccine mandates effective?
A: Marin County offers a case study in the effectiveness of vaccine mandates. In 2011 prior to the implementation of state law less than 80% of kindergartners were vaccinated. After SB277 was implemented, our county’s vaccine rate approached 95%. On December 16th, less than 120 days after the U.S. Army mandate went into effect, 98% of active-duty forces have received at least one dose. The Department of Defense is considering mandating boosters.
Q: I’m vaccinated. Why do I need to get a booster?
A: Local evidence during the Omicron surge showed that fully vaccinated, boosted persons had the lowest case rate of COVID-19 infection. Marin residents who were boosted were nearly 50% less likely to be infected than those who were fully vaccinated. Evidence shows that individuals who have received a booster shot increase their immunity and have more protection from all circulating COVID-19 variants. Evidence also shows that boosted individuals who contract COVID-19 shed less virus and are less likely to transmit the virus to others. The U.S. Centers for Disease Control and Prevention (CDC) and the California Department of Public Health (CDPH) now recommend that all eligible persons receive a booster shot because immunity wanes several months after completion of the initial vaccine series.
Q: Why require COVID-19 vaccine and boosters for people who have had a COVID-19 infection?
A: COVID-19 vaccination causes a predictable immune response compared to natural infection. Getting a COVID-19 vaccine gives most people a high level of protection against COVID-19 and can provide added protection for people who already had COVID-19. Research has shown than unvaccinated people are more than 2 times as likely to get COVID-19 again than those who get fully vaccinated after their recovery. At this time, it is unknown how natural immunity alone or hybrid immunity (vaccinated and history of Omicron infection) will protect individuals from future infections or severe illness caused by another variant. Therefore, it is recommended that all booster eligible persons get boosted whether or not they have a history of COVID infection.
Q: Why require COVID-19 vaccines and boosters when vaccinated and boosted persons developed breakthrough COVID infections during their Omicron surge?
A: Vaccination and staying up to date (i.e., getting a booster) provides robust immunity. In Marin County, at the peak of the Omicron surge, unvaccinated persons were 5x more likely to get infected than boosted persons. Boosted persons were 50% less likely to get infected than persons who had completed their vaccine series > 6 months ago.
Both vaccine-induced and infection -induce immunity wane over time. The booster dramatically increases the immune response more than five-fold over two doses of mRNA vaccines or one dose of J&J. People who are boosted and have breakthrough infections have shorter periods of being infectious and that protects the other people around them as well. Households with boosted adolescents and adults have significantly less household transmission. This is especially important among firefighters who work in a congregate setting.
Q: Will additional COVID-19 booster doses be mandated?
A: Most vaccines are 2, 3, or 4 doses and done, except for influenza and tetanus and diphtheria vaccines. Influenza viruses change enough each year to necessitate annual flu shots—note that they’re not called boosters—modified to target the circulating strains. At this time, we do not know if another COVID-19 vaccine will be recommended.
Q: If I had COVID-19 within the past 90 days, can I get vaccinated? I thought I had to wait 90 days.
A: Generally, you can receive the COVID-19 vaccine as soon as the isolation period for your COVID-19 infection ends. If you received monoclonal antibodies or convalescent plasma, you should wait 90 days to receive your vaccine.
Q: If someone received a passive antibody product as part of COVID-19 treatment or post-exposure prophylaxis, does that affect the timeline for when they must obtain vaccination or booster doses under the Order?
A: Yes. If a person received a passive antibody product (anti-SARS-CoV-2 monoclonal antibodies or convalescent plasma) as part of COVID-19 treatment or post-exposure prophylaxis, they should defer vaccination for 90 days if the product was used for COVID-19 treatment or 30 days if the product was used for post-exposure prophylaxis. A person who has received a passive antibody product for COVID-19 treatment or post-exposure prophylaxis is not considered eligible for vaccination until after the applicable deferral period.
Q: If someone tests positive for COVID-19, how does it affect when they are eligible for vaccination or a booster?
A: CDC recommends COVID-19 vaccination and boosters for persons with prior SARS-CoV-2 infection. The timing of the vaccination depends on when a person had SARS-CoV-2 infection and/or when they received treatment. Individuals with an active COVID infection should defer vaccination or booster until they have recovered from acute illness (if symptomatic) and after they have met criteria to discontinue isolation. For people who previously received passive antibody therapy as part of COVID-19 treatment, vaccination should be deferred for at least 90 days after receipt of passive antibody therapy (monoclonal antibodies or convalescent plasma).
Q: If someone is a close contact and quarantines, how does it affect when they are eligible for vaccination or a booster?
A: If a person quarantines for COVID-19, they are eligible for vaccination or a booster shot after they complete quarantine (10 full calendar days).
Q: Do unvaccinated staff with an exemption have to wear an N95 mask?
A: Yes. Unvaccinated First Responders who have an approved exemption must wear an N95 (or higher) respirator when at work.
The Order has the following requirements for unvaccinated folks with an approved exemption:
- i. Use a fit-tested, non-vented N95 (or greater) respirator at all times when at work and in shared airspace with others, including any work-related events or gatherings, regardless of their location, except when eating, drinking, bathing, or sleeping; and
- ii. Obtain twice-weekly molecular or antigen COVID-19 testing; and
- iii. When practicable, avoid using indoor breakrooms or cafeterias and avoid eating indoors or sleeping indoors when others are present in the same airspace.
Q: Under the Updated and Amended Order, Public Health strongly recommends that Law Enforcement, Fire, and EMS Personnel who enter High-Risk Setting or interact with the public obtain a booster shot. Are there requirements (e.g., testing or masking) for covered individuals who are booster eligible but have not obtained a booster?
A: Law Enforcement, Fire, and EMS Personnel who are booster eligible but have not obtained a booster must comply with the requirements in the January 28, 2022 First Responder Vaccine Verification Order. Under this Order, individuals who are not Fully Updated with their COVID-19 vaccinations/boosters must undergo once weekly COVID-19 testing.