All 2.2 million health care workers and long-term care workers in California will now have to be fully vaccinated against COVID-19 by Sept. 30, the California Department of Public Health said Thursday.

Last month, Gov. Gavin Newsom said health care workers would have the choice of either getting vaccinated or undergoing weekly testing, but the order from the state health department does not give them a choice, the Associated Press reported. There will be exceptions for religious beliefs or for those who cannot get vaccinated due to qualifying medical reasons that are confirmed with a note signed by a licensed medical professional.

The order was issued as the most populous state in the country struggles to slow infections caused by the highly contagious delta variant, the AP reported. California is grappling with the fastest increase in new cases since the start of the pandemic, averaging 18.3 new cases per 100,000 people a day.

"Increasing numbers of health care workers are among the new positive cases, despite vaccinations being prioritized for this group when vaccines initially became available," said Tomás J. Aragón, M.D., California public health officer, the AP reported. "Recent outbreaks in health care settings have frequently been traced to unvaccinated staff members."

The state's order represents a new hard line to convince the hesitant to get the vaccine. Several states are focusing on health care workers, since they are around vulnerable patients, the AP reported. The new vaccine mandate applies to workers in most health care facilities, including hospitals, skilled nursing facilities, psychiatric hospitals, adult day health care centers, dialysis centers, hospice facilities and clinics, and doctor's offices.