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Massachusetts’ largest hospital systems are setting stricter vaccination mandates for employees, no longer hinging them on full FDA approval of the COVID vaccines, amid another spike in infections and growing fears about the Delta variant.

Mass General Brigham and Beth Israel Lahey Health, along with Wellforce, the parent company of Tufts Medical Center, on Tuesday became the latest to announce that their workers must be fully vaccinated this fall.

Wellforce set a deadline of Oct. 1, while Mass General Brigham said it would give employees until Oct. 15, and Beth Israel Lahey said Oct. 31. Combined, they employ more than 130,000 people.

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In June, when the pandemic appeared to be waning, those health systems said they would not enforce vaccination mandates until the Food and Drug Administration granted full approval to the vaccines, which are currently cleared for emergency use.

But since then, infections have been rising again, driven by the highly contagious Delta variant, and hospitals in some parts of the country are overwhelmed with COVID patients. The FDA appears to be working to approve Pfizer’s two-shot vaccine in the coming weeks, but hospital leaders said they can no longer wait.

“Vaccinations are the single most important thing all of us can do to stop this pandemic,” said Dr. Anne Klibanski, chief executive of Mass General Brigham, the state’s largest hospital system and largest private employer.

“Everyone is hoping and assuming that FDA approval will come shortly, but given the safety and efficacy of the vaccines, I feel strongly we need to move ahead now and protect our patients and our employees,” she said.

Hospital workers who refuse to be vaccinated could risk losing their jobs, unless they receive exemptions for medical or religious reasons.

Massachusetts health officials reported 1,109 new COVID cases Tuesday, and the seven-day positivity rate ticked up to 2.9 percent, as the Centers for Disease Control and Prevention warned that COVID transmission is high in Massachusetts — and in most of the country.

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The number of COVID patients in Massachusetts hospitals reached 334, including 78 in intensive care. That’s four times the number of hospitalizations at the beginning of July — but far below the peak of more than 2,400 in January, and nearly 4,000 in April 2020.

“We are seeing a slow but steady increase,” Klibanski said. “We need to reverse that.”

About 86 percent of the 82,000 people who work at Mass General Brigham are fully vaccinated, and Klibanski said she is confident that the others will get their shots before the deadline. The health system already requires its employees to get annual flu shots.

Members of the Massachusetts Health & Hospital Association, which represents nearly all acute-care hospitals in the state, collectively agreed last month to require COVID vaccinations for their workers, though policies differ across organizations. Baystate Health and Dana-Farber Cancer Institute previously set Oct. 1 deadlines for workers to get vaccinated, and UMass Memorial Health Care is requiring employees to have at least one shot by Nov. 1.

The American Hospital Association estimates that one-fourth of all US hospitals — more than 1,500 — have mandated COVID vaccinations, and most of them have set deadlines.

Other employers, from tech companies to colleges to government agencies, have started requiring their workers to get vaccinated. Governor Charlie Baker’s administration last week ordered most nursing home workers to be vaccinated by Oct. 10.

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Unvaccinated people have a greater risk of catching COVID and of spreading it to others; for health care workers, this could pose a danger to their patients. It is a particular concern for patients who are immunocompromised, either because of a medical condition or because they’re receiving treatment that weakens their immune system.

That concern, along with the rise of the Delta variant, prompted Dana-Farber to update its vaccination policy in late July, said Dr. Craig Bunnell, the cancer hospital’s chief medical officer.

“The Delta variant has changed the face of the pandemic in this country,” Bunnell said. “It is far more transmissible. It is at least as severe if not more severe in outcome. We are seeing an increase in cases and hospitalizations, and we felt like it was not tenable to wait for the decision by the FDA.”

More than 90 percent of Dana-Farber’s workforce of about 5,200 are fully vaccinated.

“Mandates will save lives,” Bunnell said.

At Beth Israel Lahey, 85 percent of workers have received their shots. Dr. Kevin Tabb, its chief executive, told employees that “the longer we wait [to mandate vaccinations], the more we put our patients, communities, and one another at risk.”

Beth Israel Lahey is also delaying a return to the office for employees who are working remotely until at least January, Tabb said.

Wellforce executives told employees that “with lives on the line, it is important that we take action now.” Nearly 90 percent of their workers are fully vaccinated.

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Although people who are vaccinated can catch COVID — known as breakthrough infections — vaccines offer strong protection against severe illness, hospitalization, and death. State health officials on Tuesday said they’ve counted a total of 9,969 breakthrough infections, amounting to 0.23 percent of vaccinated people.

Vaccination rates vary widely across states. In Massachusetts, about 75 percent of adults are fully vaccinated, one of the highest rates in the country, while in Alabama only 43.7 percent of adults have received their shots, according to data compiled by The New York Times.

Hospitalizations for COVID have soared in states with lower vaccination rates, including Florida, Arkansas, and Louisiana, the Associated Press has reported, and hospitals are running low on nurses.


Priyanka Dayal McCluskey can be reached at priyanka.mccluskey@globe.com. Follow her on Twitter @priyanka_dayal.