Four of Hawaii’s major hospital systems announced today that they are requiring their employees to be vaccinated against COVID-19, joining a rapidly growing pool of healthcare employers nationally that are mandating the vaccine.

The Healthcare Association of Hawaii, the state’s trade group for hospitals and nursing homes, also announced today that it is supporting a vaccine mandate for healthcare workers.

The vaccine mandates come amid surging COVID cases in Hawaii and nationally as the highly contagious delta variant takes hold.

In just two weeks, the state’s average case count has soared 163%. On Friday, the state reported a record 622 new infections, followed by 485 on Saturday and 452 on Sunday, the three highest daily counts since the start of the pandemic.

The policies vary slightly by hospital, and are expected to include limited exceptions.

Adventist Health Castle is requiring employees to be vaccinated by Sept. 30, while Hawaii Pacific Health and Queen’s Health System has set Oct. 1 as their deadline for employee vaccinations. Kaiser Permanente also said it is requiring its employees to be vaccinated.

Hawaii Pacific Health also specified that any employee who is granted a medical or religious exemption from the vaccine, will be required to get tested regularly for COVID.

The Healthcare Association of Hawaii is also supporting mandatory vaccinations, though with the caveat that that the Food and Drug Administration first issue full approval for at least one of the available vaccines.

President Joe Biden said recently that such approval could come sometime between the end of August and October. The trade group also recommends that exemptions be provided for medical or religious reasons.

“Our board voted overwhelmingly in support of this decision,” said HAH President and CEO Hilton Raethel, in a news release. “This is the right thing to do to protect patients, residents, and employees, as well as the entire community.”