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BISMARCK, N.D.  — Sanford Health, a dominant provider of health care in the Upper Midwest, said that 97% of its workforce has complied with a mandate to be vaccinated against COVID-19 by Monday or potentially lose their job.

Sanford announced in July it was mandating COVID vaccinations for all its employees, citing the spread of more contagious variants.

The health care provider has 46 hospitals, 1,500 physicians and more than 200 Good Samaritan Society senior care locations in 26 states and 10 countries. It is based in Sioux Falls, South Dakota, and has major medical centers in Fargo and Bismarck, North Dakota, and Bemidji, Minnesota.

The company, which bills itself as one of the largest rural health care systems in the country, has a total of about 48,000 employees. Based on its estimates, fewer than 1,500 employees system-wide remained unvaccinated.

More than 90% of clinicians and 70% of nurses in the organization were already fully vaccinated when the mandate was announced this summer, system officials said. Sanford officials on Friday would only provide the overall vaccination rate among all employees.

“The vaccine mandate has worked,” Dr. Doug Griffin, Sanford’s vice president and medical officer in Fargo, said in a statement. “As a result of our high employee vaccination rate, we have also seen a decline in Covid-19 infections and sick leave among staff.”

Employees who are not fully vaccinated or don’t have an approved exemption by Nov. 1 will be suspended for up to 60 days without pay and removed from the work schedule, Griffin said.

“Continued failure to comply with the COVID-19 vaccine requirements within 60 days will result in the employee being considered to have voluntarily resigned from their employment,” he said.

“We anticipate during this time that employees will make an effort to comply with the policy and overall we expect the number of staff departures tied to the mandate will be minimal,” Griffin said.

Critics of mandatory vaccination argue it takes away people’s right to make their own medical decisions. The Biden administration, public health officials and many business leaders agree that vaccine requirements  are legal and prudent actions necessary to help the world emerge from a pandemic that has killed more than 700,000 Americans and nearly 5 million people worldwide.

The defiant workers make up a small fraction of the overall workforce, with many cities, states and businesses reporting that more than 9 out of 10 of their workers are complying with mandates.

The American Hospital Association earlier announced its support of hospitals and health systems that implement mandatory COVID vaccination policies for health care workers.

Tessa Johnson, who heads the North Dakota Nurses Association, said the group, which is a member of the hospital association, also supports hospitals and health systems with mandatory vaccination policies.

Johnson said she knows of no widespread resignations at Sanford or other health systems due to the mandatory policy. Sanford employees are already required to have several other vaccines, including annual flu shots that also need to be completed by Nov. 1. As with all vaccines, the hospital will allow certain exemptions for medical or religious reasons when it comes to the coronavirus shot.

“I’ve heard stories of nurses walking out in waves but that is not the case,” Johnson said. “It’s not the first time we’ve been mandated to do something and it probably won’t be the last time,” she said.