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San Francisco city workers will be required to be vaccinated against the coronavirus when a vaccine receives full federal approval.

The policy covering 35,000 municipal workers may be the first by any city or county in the U.S., the San Francisco Chronicle reported Wednesday.

Employees who refuse to get vaccinated and don’t get a medical or religious exemption could be fired, the Chronicle said.

The three COVID-19 vaccines currently available in the U.S. are being dispensed under emergency authorization by the Food and Drug Administration.

They are expected to receive full approval in several months. San Francisco city employees will then have 10 weeks to get their shots.

San Francisco, a compact city of nearly 900,000 residents, has had some of the strictest pandemic-related restrictions in the country. The city was among the first in the nation to order a lockdown last year and its vaccination rates are some of the highest in the nation. At least 80% of residents are partially vaccinated and 70% of those 12 and older are fully vaccinated, according to Mayor London Breed.

The vaccination policy for city employees covers a wide range of jobs but it does not include teachers, who are school district employees.

“It’s really a decision for the health and safety of our employees and our public that we serve,” said Carol Isen, San Francisco director of human resources. “It’s about protecting the city as an employer from what we deem to be unacceptable risk.”

Starting Monday, employees will have 30 days to report to the city their current vaccination status, including showing proof of vaccination by uploading a photo of their vaccination card or the QR code generated by the state’s digital verification system, Isen said.

About 55% of city employees have said they are at least partially vaccinated, according to the Department of Human Resources. About 5% of employees have said they are not vaccinated. The vaccination status of the remaining 40% is not known.

Mawuli Tugbenyoh, chief of policy for the Department of Human Resources, said that “repercussions (for refusing vaccination) go all the way up to termination. But we’re focused on the education and outreach part of it now.”

The city is the second-largest employer in San Francisco after the University of California, San Francisco. Earlier this month, the University of California reversed course said it will require all students, staff and faculty to be vaccinated against the coronavirus this fall.

UC has more than 280,000 students and 227,000 faculty and staff, and expects to return to mostly in-person instruction at its 10 campuses starting in August.

Dr. Grant Colfax, director of the San Francisco Department of Public Health, said protecting the workforce was especially important with the highly infectious delta variant gaining traction across the United States.

“Given that the delta variant is here and likely to increase in terms of its prevalence across the city, we need to do everything we can to protect our city workforce and the public we serve, especially as the city reopens,” Colfax said.