SIOUX FALLS, S.D. — With an eye on the growing threat of the COVID-19 delta variant, Sanford Health is giving its 48,000 employees until Nov. 1 to get vaccinated for COVID-19 or risk losing their jobs, the health system announced Thursday, July 22.

The Sioux Falls, S.D.-based health system is the only one in the region to set such a requirement, according to a survey of health systems such as Mayo Clinic and Essentia Health by Forum News Service.

Sanford Health's chief physician, Dr. Jeremy Cauwels, said Thursday the health system is moving forward with the mandate because of the growing number of the more contagious and virulent delta variant cases in Sanford's clinical footprint, which spans the Dakotas and Minnesota, and because national health care organizations have endorsed the move.

Sanford leaders decided to give employees more than three months to give the vaccine-hesitant time to do their research, they said. Just like the health system's influenza vaccine mandate for employees, medical and religious exemptions will be available. Employees vaccinated in the past 12 months have already met the mandate.

But for every other Sanford Health employee, the message is clear: If you want to keep your job, get vaccinated by Nov 1. And any new employees as of Sept. 1 must get vaccinated as part of their hiring process, according to an all-staff email obtained by Forum News Service.

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"It will be a condition of employment at Sanford Health," Cauwels told reporters on a Thursday afternoon media call. "If you don’t have a religious exemption or otherwise, we will be requiring it to work at Sanford."

Sanford Health is a large, regional health system with major medical centers in Sioux Falls, Fargo and Bemidji, Minn., and more than 200 clinics. The health system includes more than 200 Good Samaritan Society senior care locations in 26 states and 10 countries. Good Samaritan Society employees are included in the mandate.

More than 90% of Sanford Health clinicians and 70% of nurses have already been vaccinated, according to the health system.

Cauwels said health system leaders decided it wasn't necessary to wait for full authorization of a COVID-19 vaccine by the Food and Drug Administration (vaccines have been approved under a rigorous emergency use authorization), and the time was right to fight back against a rising tide of delta variant cases.

Federal health officials said earlier this week more than 80% of all new COVID-19 cases were delta variant.

“Nearly all new COVID-19 cases, hospitalizations and deaths are among unvaccinated people, and the overwhelming data confirms that the vaccines are not only safe, but the best and most reliable way to prevent transmission of the virus," Cauwels said in the Thursday news release about the mandate.

No mandate at other health systems

Sanford Health appears to be the only large health system in the region with a planned COVID-19 vaccination mandate for its employees.

Cauwels said Sanford Health reached out to other health systems in the region about mandating COVID-19 vaccines for employees, but finally decided to do so on its own.

"What we discovered was many of those health systems were not in the same position we were from the standpoint of readiness, whether that be due to connections with the church or due to just personal preference, they were not in the same spot we were with being ready to vaccinate folks," Cauwels said.

Forum News Service checked with Mayo Clinic, Essentia Health, Trinity Health, Altru Health System, CHI St. Alexius and Avera Health on Thursday to ask about COVID-19 vaccine mandates.

None of the health systems who got back to us require their employees get vaccinated against COVID-19. (We didn't hear from CHI St. Alexius by deadline). But they said they're eying the rise of virus cases with concern and some said an employee vaccine mandate could be on the horizon.

RELATED: Essentia, Allina health networks vary in approach to employee COVID-19 vaccinations

Avera Health in Sioux Falls said it's "evaluating the topic of requiring vaccines for employees," and several other regional health systems took a similar tack.

"We have not yet decided to require vaccination as a condition of employment," said Trinity Health Vice President Randy Schwan. "We are actively monitoring the area’s vaccination rate and virus activity throughout the region and are trying to make vaccine available for anyone wishing to help protect themselves and those around them by getting their shot.”

Essentia Health, whose facilities are spread throughout Minnesota and North Dakota, does not currently require employee COVID-19 vaccinations but said it was evaluating its options regarding an employee mandate and had yet to decide.

But some took a somewhat more guarded line, emphasizing their ongoing work to encourage employee vaccinations.

"Mayo Clinic leaders are closely monitoring the rise in COVID-19 cases and the impact of the delta and other emerging variants," the Rochester, Minn., health system said in an emailed statement. "We are gathering input on pathways to increase employee participation in vaccination."

Forum News Service reporters Jeremy Turley and Matthew Guerry contributed to this report.