Another sudden shift in state policy has triggered an array of concerns and confusion last week about how California’s still-scarce COVID-19 vaccine supplies will be divvied up.
Dr. Mark Ghaly, the state’s top health official, announced that 40% of California’s vaccine supply, starting with 2 million doses, will go to the poorest and most diverse communitIes.
“I’m lost, honestly, it’s just confusing,” one health officer said at a board meeting on March 4 of the California Conference of Local Health Officers.
The county and city health officers — who run the vaccine programs in their communities — said they weren’t pleased that they only heard about the major policy shift from news outlets. Community clinics, which provide health care in those neighborhoods, also said they were not notified.
Local health officials also highlighted a more immediate concern: As Sutter Health, one of the major vaccine providers in California, cancelled tens of thousands of vaccine appointments for lack of supply, county-run vaccine clinics are starting to see “Sutter refugees” — people who are scrambling to get their second doses before a certain deadline.
The communities receiving the 40% encompass 400 of the state’s ZIP codes, largely in Los Angeles County, the Inland Empire and the Central Valley, based on their low scores on the “Healthy Places Index,” which measures criteria such as income, education, park access, air pollution and housing.
Ghaly said about 1.6 million doses already have been administered to the underserved communities that the state is now targeting. So now those communities will receive at least 400,000 doses more in the next two weeks, double the current supply.
People in those ZIP codes must still meet eligibility requirements before they can be vaccinated — at this point, people 65 and older, health care workers, educators and some other essential workers.
Many questions remain about how the state will ensure doses get into the arms of people in those communities. Many counties and cities, particularly Los Angeles, Oakland, Richmond, Sacramento, Long Beach and San Diego, have affluent neighborhoods right next to poor neighborhoods. And some ZIP codes, such as one in Hawthorne and Manhattan Beach, contain both types of neighborhoods.
More appointments through the vaccine registration site, MyTurn.ca.gov, will be reserved for people living in the priority ZIP codes — an attempt to keep people from wealthier communities away.
And community clinics, which serve underserved communities, will be prioritized in the new vaccine network led by Blue Shield, Ghaly said. The state will also have mobile vaccination clinics and add resources for people who are homebound, he said.
“Sending (vaccine) there is one thing, but ensuring it gets to the arms of those living in these communities is another,” Ghaly said.
Michael Osur, assistant director for the Riverside County department of public health, said the state’s new plan doesn’t necessarily change what his county is already doing in its communities.
Riverside County, for example, already sends five mobile clinics to disadvantaged communities, including to agricultural workplaces in the Coachella Valley. Those areas fall within the bottom quarter of the Healthy Places Index.
“This is what we’ve been doing…now we hope and pray it means more vaccines for those groups because we need double, triple the vaccines we have now,” Osur said.
Statewide, only about 16% of total vaccines administered have gone to people in the bottom quarter of the Healthy Place Index. In comparison, 34% of the state’s vaccines have been administered in communities in the highest quarter.
Gov. Gavin Newsom addressed the inequalities and the attempts by some people to jump in line at a press conference on March 4.
“We are working on this whack-a-mole every single day … I’ve seen this (problem) firsthand,” he said.
Newsom described how he was at a public housing site in East Los Angeles that has mostly Latino residents and saw “Audis pull up, folks that look like me” at a popup FEMA vaccine site for the neighborhood. “What happened is there was a code that went out on the app that was shared outside of the community… We’re seeing that in other parts of the state.”
To resolve this, Newsom said “instead of having group codes, we’re now doing individual scheduled codes to make that more challenging and create more burdens and obstacles for people abusing that privilege.”
Advocates who have been pushing Newsom for a more equitable plan to help people of color — particularly Latino essential workers who are at high risk of infection — applauded the state move to prioritize those communities.
“The state’s new approach is the right step to stop the bleeding and affirm that Californians of color are not collateral damage but the catalysts to recovery. California has a responsibility to those communities to get them help first and fast,” said Sonja Diaz, founding director of the UCLA Latino Policy and Politics Initiative.
But the state’s new approach may leave out people disproportionately affected by the pandemic who don’t live in the targeted ZIP codes, said Anita Zamora, deputy director and chief operations officer of the Venice Family Clinic, the largest community clinic in Los Angeles’ Westside district.
Zamora, a registered nurse, said she supports the idea of sending more doses to California communities hardest hit by the pandemic. But this policy shift won’t help her patients. The clinic has 11 locations serving 27,000 low-income, predominantly Latino patients, but none are in those ZIP codes, she said. It also runs the largest street medicine program for homeless people in Los Angeles. But the clinic currently receives only 200 doses each week, even though it has capacity to immunize 2,000 people weekly, Zamora said.
“The doses are going to be routed to other neighborhoods,” Zamora said. “Why are we not part of this multi-pronged effort? It is frustrating.”
The allotment of 40% to certain communities also raises questions about whether other populations of Californians will be pushed lower on the priority list. In addition, another 10% of doses have been earmarked in California for teachers and child care workers.
If those groups are prioritized for 50% of the doses, it follows that other groups — particularly people outside those ZIP codes who have high-risk health conditions — will be less of a priority.
Ghaly, however, said he expects vaccine shipments to increase over the next couple weeks, so he thinks other groups will not lose out. He predicts that all communities soon will get at least as many doses as — or more than — they currently receive.
“Of course targeting scarce resources to certain ZIP codes, certain communities, certain eligible populations is going to mean that some communities don’t get as much of an increase as others. But we expect that all communities will get at least as much as they’re getting now,” Ghaly said.
Ghaly said a disproportionate number of people with chronic conditions or disabilities live in the prioritized ZIP codes.
Californians with cancer, heart disease, diabetes and other high-risk disorders become eligible for vaccines on March 15. Guidance on how they can verify medical conditions and access vaccinations will be released in the coming days, Ghaly said.
Advocates have criticized California’s vaccination program for failing to serve poor communities of color, which have been battered by a high rate of COVID-19 infections.
California has adjusted its priority system several times since vaccines became available in December. It first put out a system based on employment and medical conditions, with health care workers and nursing homes prioritized. Then the state announced seniors 65 and over would be eligible to sign up, although some counties initially only opened it up to those 75 and over, noting lack of vaccine supply. Teachers and child care workers, along with some essential workers, such as food and agriculture, are now also eligible. State officials have said that after essential workers and people with underlying medical conditions, vaccination eligibility will be based on age.
The result is a dizzying array of constantly shifting priorities that confused and worried local health officials and advocates.
“Communities of color are much younger in age than non-Hispanic whites, and the state’s previous age-based criteria for vaccine access put them at a disadvantage,” said Carmela Castellano-Garcia, president and CEO of the California Primary Care Association.
Dr. Jeffrey Reynoso, executive director of the Latino Coalition for a Healthy California, said Latinos represent only 17% of those receiving the vaccine, far below their 39% share of the state’s population, “making it clear that more needs to be done.”
Osur said his team is still looking for information on exactly which ZIP codes qualify. The Healthy Places Index, which has been updated within the last 18 months, is designed off census tracts, not ZIP codes. Epidemiologists, however, work with this system a lot and have a good idea of where ZIP codes fall.
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