West County Health Centers (WCHC) recently pivoted toward scheduling COVID-19 vaccinations through direct outreach instead of open self-registration to effectively prioritize groups most at-risk.
As of Feb. 24, WCHC has conducted 5,600 vaccinations since they began, counting 313 second doses, and will deliver 3,200 doses this week if the supply allows, a press release from WCHC said.
In addition, 24 state-funded SnapNurses have joined WCHC staff and over 40 volunteers to pull off their mission to vaccinate the west county community, the press release said. Jennifer Neeley, WCHC associate director of development, said the nurses are on-demand crisis response workers.
The state’s move to integrate Blue Shield as its third-party administrator for vaccine distribution also led to the switch to direct outreach. WCHC is testing out Blue Shield’s appointment tool, MyTurn, this week and will start up with Blue Shield alongside Sonoma County’s other federally qualified health centers on March 7, the press release said.
Jason Cunningham, a doctor and WCHC’s chief executive officer, said the center made the shift last Wednesday, when they would normally post appointment openings for the upcoming Monday through Saturday after receiving their vaccine shipments from Sonoma County.
The press release said the direct outreach method improves eligibility screening because the health centers, primary care providers and essential worker employers identify qualifying individuals, while the PrepMod platform would allow anyone to register regardless of their eligibility.
“The amount of work that we took to make sure that those people were eligible was a vast amount of energy. It just didn’t work,” Cunningham said. He said the executive team would call individuals who didn’t clearly qualify to verify and that he spent hours a day doing so.
While organizations that hire essential workers contact their employees, Cunningham said WCHC is also using a frailty index to assess who is most vulnerable among their lists of patients ages 65 and older to make outreach calls.
Individuals ages 65 and older and qualifying essential workers can get their COVID-19 shots now, and WCHC vaccinates people who live or work in west county or receive primary care from a west county-based provider, according to the press release.
Guerneville Elementary School and Analy High School are still open as WCHC community vaccination centers, “but we are aware of the potential for a radically different next phase in which it’s possible that WCHC may continue to experience disruption based on vaccine shortages if larger volume sites are prioritized,” the press release said.
WCHC prioritizes second vaccinations in supply management
Because of state changes in vaccine supply and allocation patterns, Cunningham said WCHC is directing incoming shipments towards ensuring people receive their second doses until word comes from the county or Blue Shield “that we have sufficient supply for first and second vaccines.”
The impact is that residents and workers becoming eligible may wait longer to receive their first dosage of the COVID-19 vaccine, Cunningham said.
“And that may change. It changes every day, potentially, but right now, we’re not cancelling anybody,” he said. “But we are not starting any new community vaccination clinics or essential worker clinics until we know we have sufficient supply to meet our second vaccine commitments and for a longer-term supply.”
According to the press release, “the existing vaccine allotment from the state was less for the first time the week of Feb. 15 as other counties throughout the state that are in the first phase of the third-party administrator roll-out received more doses and the winter storms limited distribution of promised vaccines.”
Cunningham said WCHC has enough vaccines to give people their second shot for the time being and continues to receive vaccines each week, an allocation that varies weekly depending on the county’s supply since the community vaccination clinics started.
What’s different now is that aside from the weekly allocations, the county and state no longer guarantee that each shipment of vaccines WCHC receives will have an associated secondary shipment delivered automatically a few weeks later, he explained.
WCHC now manages the deliveries as doses rather than assuming certain shipments will be for first shots and others for second shots, since the first and second doses of the COVID-19 vaccine are the same, Cunningham said.
The direction to prioritize second vaccinations comes from the Centers for Disease Control and Prevention, the California Department of Public Health and the county, he said.
“What’s happening is, the 65-year-old … and restaurant workers who are now in line are going to have to wait a little longer,” he said. “Which is a big deal.”
Distribution is fluid, so WCHC could end up with the supply to offer appointments to newly eligible age brackets and workers next week, but as it stands, appointments for second shots will come first, he said.
Cunningham said he regrets not being able to move “full-force” to get first vaccinations started, but good about getting patients fully vaccinated.
Navigating vaccine equity through the shift
Cunningham said working with organizations to set up appointments for essential workers has been highly successful. According to the press release, WCHC approximates 85% of west county’s vineyard workers have been either vaccinated or scheduled for an appointment, partnering with organizations like Sonoma County Grape Growers, the Sonoma County Farm Bureau and Sonoma County Vintners for outreach.
A significant number of H-2 visa workers have received COVID-19 vaccines, Cunningham said. Overall, 906 essential workers were vaccinated among the 5,600 doses given by WCHC, per the press release.
There’s still work to do in terms of equity in the new scheduling method. “The gap is for people who can’t get to their health system or don’t have a health system, or uninsured,” Cunningham said.
“One of the reasons we’ve set up the way we set it up is it shouldn’t be dependent on your health system. It should just be if you’re eligible, you should be vaccinated. I worked hard for that,” he said. But again, calling between 50 to 100 patients daily wasn’t effective for reaching the most vulnerable.
“And because people signed up within hours, it wasn’t an equitable way of doing it. So, even if everybody was signing up in good faith, the people who had the fastest internet and the fastest sign-up were the ones getting it,” he said.
Maintaining access to vaccines for anyone stranded outside a health system remains one of his priorities, so WCHC is working to set up a phone number this week for people who think they qualify to call so someone can screen them and sign them up if they’re eligible, he said.
He said the goal was to either provide an internal number or contract an organization with bilingual, bicultural staff.
