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The University of Pennsylvania Health System and RWJBarnabas Health have joined Houston Methodist in mandating employees get vaccinated against COVID-19, spokespeople for the two health systems confirmed Thursday.

Penn Medicine in Philadelphia is dictating all clinical and other employees get fully inoculated by September 1. RWJBarnabas in New Jersey is requiring supervisors and executives to be fully vaccinated by June 30; the system has not issued a mandate for all employees, but "it is anticipated that it will eventually be required," its spokesperson wrote in an email to 麻豆传媒. Both systems are allowing employees to apply for medical or religious exemptions.

The two health systems cited the need to set an example for the public, as well as evidence supporting the vaccines' efficacy and safety, echoing sentiments shared earlier this spring by Houston Methodist.

"As an institution grounded in the science and art of healthcare, we believe it is imperative for Penn Medicine to take the lead in requiring employee vaccinations to protect our patients and staff and to set an example to the broader community," said CEO Kevin B. Mahoney, MBA, in .

"The evidence is clear that COVID-19 vaccines have proven to be very safe and highly effective at preventing transmission, hospitalizations, and death from the virus," said Chief Medical Officer and Senior Vice President Patrick J. Brennan, MD, in the release. In addition, he noted that Penn researchers contributed to the development of the mRNA technology used in the Pfizer-BioNTech and Moderna vaccines -- which "further buoys our confidence in the science."

"As a healthcare leader in the state, we must set the precedent to always provide the safest environment," said Barry H. Ostrowsky, president and CEO of RWJBarnabas, in .

Penn Medicine's decision makes it the largest health system to issue a vaccine mandate, according to the release. It is the largest private employer in Philadelphia, .

Almost 70% of their roughly 44,000 employees are already fully vaccinated. Starting July 1, new hires must be vaccinated or get vaccinated 2 weeks before beginning work there. They will be holding vaccine educational sessions and making experts available to answer employees' questions through this summer.

RWJBarnabas counts 9,000 physicians, 1,000 residents and interns, and more than 35,000 employees at 11 acute care hospitals, among other facilities, in nine New Jersey counties. Among the system's staff at the supervisor level and above, 83% have been vaccinated.

How the systems will handle employees who decline to get vaccinated may vary. While Houston Methodist is terminating uncooperative employees, Penn Medicine employees who do not follow the new mandate "will be subject to disciplinary actions, including firing," according to the Inquirer, citing a Wednesday memo to employees.

"We recognize that not everyone [at Penn] will agree with this decision," the memo said. "The threat of further harm and the possibility of more dangerous viral mutants emerging before we reach herd immunity compels us to take this step."

RWJBarnabas is finalizing its policy "over the next several days," its spokesperson said.

Houston Methodist's mandate did not motivate RWJBarnabas to instill its own, the spokesperson added. "Our decision was made because this mandate is in the best interest of our patients and our staff."

Penn Medicine leaders have been "discussing when a mandate might be appropriate to implement" since the system started vaccinating staff in December, its spokesperson noted. Leaders are "hopeful that other organizations will follow our lead and that of Houston Methodist in taking this step."

Houston Methodist has also been allowing employees to apply for exemptions, which are based on U.S. Equal Employment Opportunity Commission guidelines, a spokesperson wrote in an email to 麻豆传媒. The system does not have updated data on how many exemptions have been granted.

Some employees have opposed Houston Methodist's mandate -- with one executive being terminated for refusing to be inoculated, two others resigning rather than get the shot, and a nurse taking her grievances public. The system has not adjusted its requirements and has no plans to do so, according to an email from CEO Marc Boom, MD, shared by a spokesperson.

Jefferson Health in Philadelphia is also considering a vaccine mandate, the Inquirer reported.

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