Gabriel Montoya, an emergency medical technician, watched in horror as gasping patients overwhelmed the intensive care unit at Kaiser Permanente Downey Medical Center in southeastern Los Angeles County late last year. Eight out of 10 admissions were infected with Covid-19 at one point.
“Even with all that — with the amount of people who died, the amount we saw intubated,” Mr. Montoya said, he and his fellow union leaders have had trouble getting even half of the 300 rank-and-file members in the hospital’s emergency room vaccinated.
He said he had tried to use shift huddles as a time for gentle persuasion, but “you get the rolling of the eyes and the walking away as soon as you mention vaccinations.” So as California moved this week to require two million health care workers to get immunized or submit to weekly testing, his hope was tempered with skepticism.
“I hear the water-cooler conversations. ‘What are they going to do if we refuse? Get rid of us all when they’re having a spike in cases?’” said Mr. Montoya, who has been vaccinated. “I’m relieved, but if I’m being honest, I’m doubtful about how much this actually will motivate anyone.”
Confronted with surging infections, California this week became the first state to mandate coronavirus vaccines or regular testing for state employees and health care workers. Starting next month, all public- and private-sector health care workers, along with some 246,000 state government employees, will have to show proof of vaccination. If they cannot, they will be required to wear face masks at all indoor work locations and to be tested at least weekly, and in some cases several times a week.
No state has vaccinated more people against Covid-19, but infections in California have risen sharply, largely because unvaccinated people are spreading the hypercontagious Delta variant. Most of the state’s labor groups and hospital systems have been publicly supportive of the new rules announced by Gov. Gavin Newsom, including the California Medical Association, the California Nurses Association and Kaiser Permanente, which said it would require all of its employees nationwide to get vaccinated or tested regularly.
But pockets of vaccine resistance have been stubborn, even in liberal-leaning California, where the vaccination rate is relatively high and where many people take the virus so seriously that they choose on their own to wear masks indoors or outdoors. Like the state as a whole, where about 52 percent of the population is fully vaccinated, the government and health care work forces and their unions include a striking number of vaccine resisters.
Take S.E.I.U. Local 1000, which represents 96,000 state workers.
Sophia Perkins, 58, an unvaccinated state employee who processes death certificates for the Department of Health Care Services in Sacramento and is a union member, said she would be “forced into retirement” rather than adhere to the new rules. Throughout the pandemic, she said, she processed more certificates involving suicide than the coronavirus. Her experience, combined with posts she had seen on social media claiming that the vaccines caused illness, persuaded her that she would not get inoculated or submit to regular testing.
She will not reconsider, she added, until the federal Food and Drug Administration officially approves a vaccine — three are currently authorized for emergency use — or until she sees more extensive testing. “Nobody should mandate somebody else to inject poison into their body,” Ms. Perkins said. “There’s not enough research on this vaccine.”
Denise Quinn-Allen, 51, who processes unemployment claims in Anaheim and is a representative with the same union, said she was infuriated by people who claim that “their right to choice on the vaccine is more important than the health of the American people.”
She and others blamed a growing conservative faction in the local, which represents a wide range of clerical and other state workers. “All of this hissing and moaning and crying that, ‘It’s my body, my choice,’ it’s ridiculous,” said Ms. Quinn-Allen, who said she was vaccinated and whose wife is recovering from cancer. She said the new rules did not go far enough, and wondered whether they would make a difference.
“The ignorance,” she said, “is strong.”
Richard Louis Brown, the new president of the local, said the two views were emblematic.
“This country is split down the middle on these vaccines, and we are no different,” he said. His sense of duty to his co-workers and their vulnerable relatives led him to choose to get vaccinated, he said, but “if you don’t trust how Covid came to America, and you don’t trust this government, and you don’t trust this vaccine that is not F.D.A. approved,” he added, “then I support you, too.”
Enforcement of the vaccination-or-testing mandate is likely to be a significant hurdle. The Newsom administration said compliance at hospitals, skilled nursing centers, jails, homeless shelters and other congregate care settings would be administered through the state’s various regulatory bodies.
Employees who refuse to get vaccinated will be required to maintain social distancing and wear personal protective gear such as face masks. In high-risk settings, such as nursing homes and acute care facilities, unvaccinated workers will be tested twice weekly.
Health officials said the hope was that vaccination would become the less onerous option. But some managers and union leaders say the administration has yet to provide specifics on how testing and vaccine documentation will be managed when the new rules roll out next month.
On Tuesday, the California State University System joined the University of California in mandating vaccines this fall for all students, faculty and staff on campus. The city of Long Beach, whose mayor is a political ally of Mr. Newsom, also announced that employees would have to get vaccinated or tested weekly. The Los Angeles mayor and president of the City Council said city employees would be required to show proof of vaccination or submit to weekly testing starting this week.
Some state employees may pose more of a challenge than others.
Only about half of the thousands of unionized prison guards working in California’s vast correctional system have received a vaccine dose, according to Donald Specter, the executive director of the Prison Law Office, a nonprofit public interest law firm based in Berkeley, Calif.
Mr. Specter, whose group monitors prison health care as part of a longstanding case against the California Department of Corrections and Rehabilitation, said his group had been urging the state since March to make vaccination mandatory for prison workers. But, he said, prison guards have tended, politically, to be among the state’s staunchest vaccine opponents.
“It’s no secret that many of the staff who work in prisons are not progressive liberals,” Mr. Specter said.
The state has offered pandemic bonuses to correctional officers and set up walk-in vaccine clinics in the prisons, and created a program to educate staff about the benefits of a vaccine. And Glen Stailey, the president of the California Correctional Peace Officers Association, which represents those working in state prisons, said in a statement the new vaccine policy was “a reasonable compromise.”
But since April, Mr. Specter said, the percentage of prison staff that has received at least one vaccine dose has moved only slightly, from 44 percent to 53 percent of employees. According to the state corrections department, there have been at least 279 new Covid-19 infections among state prison workers in the past 14 days.
Health care workers say that in their workplace, too, the resistance is surprisingly hardened. Dr. Frank Candela, a surgeon at West Hills Hospital in Los Angeles’s San Fernando Valley, said the vaccine debate had even come up around the operating table.
“The nurse will bring up, the anesthesiologist will bring up their concerns,” he said.
Dr. Candela said that he got both doses of the Pfizer-BioNTech vaccine as soon as they were available, but that his wife, a registered nurse, feared it could alter her DNA and had not yet been inoculated. She has also prevented their four children, who are vaccine-eligible and living at home, from getting vaccinated, he said. (The vaccine does not alter DNA.)
“It creates a great deal of stress in the household,” he said. When his 18-year-old son told him he was going to get vaccinated, Dr. Candela said he warned him: “Get ready for getting yelled at by Mom.”
Mr. Montoya serves on the statewide executive committee at S.E.I.U.-United Healthcare Workers West, where members are largely employed by private health care companies such as Dignity Health and Kaiser Permanente.
He said that he doubted that many of his colleagues could afford to quit when the new rules take effect, but that he would not be surprised if many opted for the inconvenience of masking and testing — and then tried to take legal action against their employers. Kaiser Permanente officials said that they did not have departmental data, but in the hospital overall, nearly 80 percent of the Downey employees were now vaccinated.
“Our I.C.U. was filled, people on ventilators, 80 percent of them not getting out alive,” Mr. Montoya said. “It’s heartbreaking to see how willing some people are to put not only their patients and themselves at risk.”