The Colorado Board of Health voted overwhelmingly Monday to require licensed facilities vaccinate their workforce against COVID-19 by Oct. 31, two weeks after Gov. Jared Polis requested the board adopt the rule.

The board voted 6-1 to adopt the emergency rule, which its members emphasized was not the final hearing or adoption of a permanent requirement. The mandate places the onus upon the state’s roughly 3,800 licensed, certified health care facilities to ensure their workforces are vaccinated, officials said, and individual providers will not face threats to their license if they refuse to be vaccinated. But the facilities themselves may be penalized, up to the revocation of their license, officials said Monday, and it is on them to adopt policies to vaccinate their staff.

The vote came after roughly 90 minutes of public comment, which was a mix of pro- and anti-vaccine requirement speakers. Several board members said they were hesitant to institute any mandates. But they acknowledged the state is in a “bad spot,” in the words of board member Shawn Turk.

“I’m reminded by my fellow board members that my duty here is to protect the health of Coloradans, particularly the most vulnerable, and to represent the people of Colorado,” board member Evelinn Borrayo said. 

“Not only is our mandate to protect the people of Colorado, but our mandate is also to follow the evidence of the science,” added Patricia Hammon, the president of the board. She warned about future variants that may continue to exacerbate the situation. “The more we can get things under control now, the better off we’ll be.”

Polis wrote to the board Aug. 17 to ask them to institute the mandate. Days before, 19 health care organizations in the state – including the medical society and hospital association – signed a letter supporting vaccine requirements of health care workers. Many major hospital systems have reported that their employees’ vaccine uptake is above 80% or 90%, and the statewide vaccination rate for long-term care staff is over 70%, according to state data. 

Several systems – including UCHealth, Denver Health, Banner and SCL Health – have all said they’ll require all of their workforce to be inoculated in the coming weeks.

The most prominent criticism to come out of public comment, voiced even by some supporters of the requirement, was the potential effect such a mandate would have on facilities’ workforces. Many are already strapped for employees, industry officials told the board, and they said they’ve been told by their staff – particularly at long-term care facilities – that many will quit if required to be inoculated.

Janet Cornell, an administrator for an assisted-living group home, testified that she’d have to discharge 12 patients if staff were required to be vaccinated. Nicole Schiavone of Wildflower Assisted Living warned that some facilities are expecting to lose between 10% and 20% of their workforce. 

But Doug Farmer, who runs the nursing home group Colorado Health Care Association, said that though staffing was a concern, those fears were alleviated by the mandate being universal. If it were specific to certain types of facilities – like nursing homes – then staff could simply leave a nursing home and work elsewhere in the health care industry in the state. 

He said the state will support facilities that need staffing and will provide funding to buttress them. Still, concerns about staffing prompted the board’s one no vote. Kendall Alexander, of North Range Behavioral Health in Greeley, said he feared that any mandate would drive more mental health providers into telehealth companies that wouldn’t be under the authority of the state.

Many of the anti-mandate comments attacked the efficacy of the vaccine and assailed any mandate as an assault on individual liberty. One Colorado Springs physician promoted the use of ivermectin, a drug used to de-worm humans and animals, to treat COVID-19 instead of requiring vaccines.

The use of ivermectin against COVID-19 has been heavily criticized by leading health officials and agencies. Mississippi’s public health department reported that 70% of calls to its poison control center were made because of ivermectin use earlier this month. The drug’s manufacturer, Merck, said in February that there was “no scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies.” One study supporting its use has been retracted.