Employees of Philadelphia’s higher-education and health-care systems must be vaccinated by mid-October or wear masks while indoors and get tested for COVID-19 at least once a week, city officials announced Friday.

Under the new mandate, all students and employees must be vaccinated by Oct. 15 unless they have religious or medical exemptions, acting Philadelphia Health Commissioner Cheryl Bettigole said.

Health-care workers who receive an exemption and do not get vaccinated will be required to wear a mask and get a PCR or antigen test twice a week, Bettigole said.

Unvaccinated college students and staff will be required to wear a mask indoors, and get a PCR test once a week or an antigen test twice a week, Bettigole said. Once a college reaches a 90% vaccination rate, unvaccinated people can forgo testing but must wear a mask indoors.

The Philadelphia Board of Health voted to institute the mandate on Thursday due to the delta variant’s high transmission rate and fast climbing infection rates among college-age students. The board was also concerned that soon the city’s colleges will bring in tens of thousands of students, including from places with higher levels of infection than Philadelphia, said Marla J. Gold, vice provost for community health care innovation at Drexel University and a member of the city’s board of health.

”This protects the students,” Gold said. “It protects the workers. It protects the people who live in Philadelphia.”

Bettigole said officials discussed the mandate “extensively” with the city’s law department, and the Board of Health has the authority to enact vaccine mandates during an emergency such as the coronavirus pandemic. It is possible that the city will expand the vaccine mandate to include more categories of people, Bettigole said.

”This is what we’re doing today. and we’re hopeful that this will be enough to control the spread and to protect the people who are most vulnerable,” she said. “I can’t promise you that we wouldn’t be adding other groups to this. It just depends what happens.”

Under the new regulations, “health-care worker” includes employees, contractors, students and volunteers who work in-person at an organization that provides health-care services — regardless of whether their job includes direct contact with patients.

Home health aides and nursing-home workers, who Bettigole said are “some of our highest-risk and lowest-vaccinated workers,” are included.

At All American Home Care, which includes a Philadelphia location employing about 1,000, just 30% to 35% of workers statewide are vaccinated, said Michael Spivak, the company’s chief executive officer. The company has professional employees who visit clients at their homes, and family caretakers providing assistance to relatives and are paid through Medicaid. The majority, though not all, of the agency aides are vaccinated, Spivak said. Few of the family aides are.

“It’s a fairly low number,” he said. “I think with everything being mandated right now in Philadelphia with the vaccines I’m 100% sure the number is going to go tremendously up very fast.”

He was relieved by the city’s mandate. Facing staffing shortages, he was concerned about a backlash from workers who don’t want to be vaccinated if he had imposed a mandate just for his company.

“It’s one thing if I would have mandated it for my company, and then the employees would have another choice” to seek work elsewhere, Spivak said. “Since now the city, and I’m sure soon the state, will mandate these things, it’s not a policy I’m putting into my organization, it’s coming from the top. They have nowhere to go.”

But multiple mandates from state and local health departments — each slightly different — could be confusing and contribute to a worker shortage in long-term care, said Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, which represents nursing homes.

“That will give our front-line workers a reason to leave and go to other settings,” Shamberg said. “Pennsylvania needs to be ready to support long-term care providers who are still very much at the epicenter of the coronavirus pandemic ... because there will be workforce issues.”

Earlier this week, Pennsylvania said nursing homes that don’t have at least 80% of their staff vaccinated by Oct. 1 will have to undergo routine staff testing.

Less than 13% of the 700 nursing homes statewide, excluding Philadelphia, have reached or exceeded 80% of staff vaccinated, according to the Pennsylvania health department. Overall, about 60% of nursing home staffers in Pennsylvania are vaccinated.

Chester County-based Genesis HealthCare, which operates 250 skilled nursing centers and senior living communities in 23 states, has not seen a significant loss of workers since announcing in early August that it would require vaccination for all staff.

“We believe that these vaccination requirements will become far broader, especially in health care, so employees have had to weigh that consideration, as well. As a result, we hope that the ultimate staffing implications will be limited,” said Lori Mayer, a spokesperson for Genesis, in an email.

People who work from home entirely do not have to get vaccinated. The vaccine mandate also does not apply to grocery stores, convenience stores, pharmacies, membership-based warehouse stores and other businesses that may provide health-care services but are primarily retail businesses.

Philadelphia’s largest health systems have already mandated that staff be vaccinated. Thomas Jefferson University will require staff within its health system and those in non-medical fields to get vaccinated by Oct. 29. Children’s Hospital of Philadelphia set a deadline of Oct. 20 for staff to get inoculated. Penn Medicine was the first to require COVID-19 vaccination when it announced in May that employees would need to be vaccinated by Sept. 1.

Most Philadelphia universities had also instituted vaccine mandates for students, faculty, and staff before returning to campuses this fall, including the University of Pennsylvania, Drexel, La Salle, Holy Family, Thomas Jefferson, and St. Joseph’s University. The Community College of Philadelphia required faculty and staff to get inoculated by Oct. 1, and students by Jan. 18. Exemptions for medical and religious reasons are allowed.

Temple said in a statement that it stands ready to implement the new vaccine requirement. The university already had planned to require students and employees who weren’t vaccinated to be tested weekly for the virus.

“Public health experts have made it clear that widespread vaccination is our best defense in the fight to mitigate the virus, and to restore the joy and value of gathering with families, friends, and colleagues,” Temple president Jason Wingard said in a statement. “It is also the responsible action to protect the health and welfare [of] our communities.”

Bradley A. Smutek, president of Temple’s student government, said he was elated.

”This is what needed to happen,” the senior history major said. “The vaccines are safe. They are effective. They are by and large now accessible and the city is going to make them more accessible. This is exactly what we needed to get back to normal.”

Vaccinations for city elections staff

Philadelphia’s election officials, the city commissioners, announced Friday that their staff will need to be fully vaccinated by Oct. 1, with double-masking and weekly testing requirements beginning Sept. 17 until everyone is vaccinated.

Pennsylvania’s 2021 municipal election will be held Nov. 2, and the work of running elections begins far earlier. By October, as election workers are on tight timelines, much of that work must take place in person, including setting up voting machines and other equipment and processing voter registration forms and mail ballot applications.

A disruption to that work could have serious consequences, elections chief Lisa Deeley said in a statement. ”An outbreak among our staff could jeopardize democracy in Philadelphia,” she said.

Staff writers Sarah Gantz, Jason Laughlin, and Jonathan Lai contributed to this article.