A vial of the Modern COVID-19 vaccine and syringes on a table in a unit across the distribution site at Cal Expo in Sacramento on January 21, 2021, photo by Anne Wernikoff, CalMatters
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Melinda McKee is looking forward to receiving her COVID-19 vaccine. The medication she takes for a rare form of arthritis makes her immunocompromised and at high risk of becoming seriously ill from infections. But she is only 33 and, at the current vaccination rate, it may take months before she can get the vaccines.
After filling out a questionnaire from his provider, McKee knew he would likely fall into Phase 1C of the state’s vaccination plan, alongside millions of other Californians with underlying medical conditions. It is not certain, however, because the state has not yet defined which conditions would be included in this phase. This would put it ahead of the healthy population in general, but behind the elderly, millions of essential workers, homeless people and incarcerated people.
“It is a pity that immunocompromised people have to wait so long. I think we are just as vulnerable, if not more so, than a healthy 65-year-old, ”said McKee, from Los Angeles.
With more than 35,000 deaths from COVID-19, pressure has increased for the state to vaccinate people more quickly, especially those most vulnerable to a severe form of the disease. But continued limits on dose delivery are forcing the state’s top public health officials to make tough decisions and choices. They say the overarching question behind their decisions is this: How can they save more lives? As the virus evolves and vaccine supply fluctuates, the only thing that is certain is that your plans need to be flexible.
“It is painful for all of us every day. And the challenge we have is that we don’t have enough vaccines ”.
– Dr. Nadine Burke Harris, general surgeon for the state
“We are between a rock and a difficult position,” said Dr. Nadine Burke Harris, the state’s surgeon general, during the vaccine advisory committee meeting last week, where health advocates, the elderly and disabled, union representatives and community groups sometimes heated and passionate discussions about state proposals and slow progress.
“It is painful for all of us every day. And the challenge we have is that we don’t have enough vaccines, ”said Burke Harris.
About 12 million people are eligible for the vaccine now, according to current state guidelines. The state has received nearly 5 million doses and has administered about 45% of them to date. Each person requires two doses. There are about 30 million adults in the state, and some experts estimate that at least 70% of the population needs to be immunized for widespread protection.
The vaccine advisory committee does not make the call about who goes next, but members can defend their own constituents. Some want to keep it simple and distribute vaccines by age. Others argue that this would not be fair for rural workers and grocery workers, essential workers who are generally younger but highly exposed. Some members said last week that they were concerned about the rapid availability of the vaccine in postal codes that are critical hotspots for viruses. Others asked about people under 65 with disabilities and pre-existing conditions.
Earlier this month, following federal guidelines, the state announced that people age 65 and older would be eligible to receive a vaccine – although how quickly older people can make an appointment varies by county. California public health officials said vaccination in this age group will help reduce deaths and relieve pressure from hospitals under pressure. These elderly people represent about 11% of cases, but almost three quarters of deaths in the state.
Although federal guidance also encourages states to start vaccinating people under 65 with certain documented medical conditions, California public health officials decided that the offer was too limited to include them. It would potentially take tens of millions of additional doses to vaccinate this group.
For example, expanding eligibility for people with diabetes would add millions to California’s immediate deployment; about 3 million adults are diabetic in California, including those over 65. Diabetics are at an increased risk of becoming seriously ill due to COVID-19, according to the United States Center for Disease Control and Prevention. Other conditions that make people at high risk include cancer, heart disease, chronic obstructive pulmonary disease, obesity and sickle cell disease.
However, eligibility decisions can be modified at any time, depending on the state’s vaccine supply. Public health officials heard advice on phased implementation from a panel of medical experts that includes Dr. Mike Witte, medical director of the California Primary Care Association. “Epidemiologists know how many people are in each of these layers … so they can match that with how many vaccines are being distributed,” said Witte.
The state is receiving between 300,000 and 500,000 doses of vaccine per week. So far, it is not clear whether President Joe Biden’s goal of vaccinating 100 million people in 100 days would increase California’s supply. But at the current rate, the state would not finish immunizing people aged 65 and over until June, said Dr. Erica Pan, the state’s leading epidemiologist, during last week’s vaccine counseling meeting.
In addition to supply problems, some experts also blame California’s inefficient system, where rules vary by county and health care system, for the slow implementation of vaccination. As a result, confusion arises as to who is eligible to be vaccinated and when.
About 12 million people are eligible for the vaccine now, according to current state guidelines. The state has received nearly 5 million doses and has administered about 45% of them to date.
Anthony Wright, director of Health Access and a member of the vaccine advisory committee, said that an effective vaccine plan needs to be easy to understand. “I find age attractive because of the simplicity and clarity in being able to communicate this to the public; it is very simple to know when you are eligible based on your age, ”he said.
While it is worth considering faster immunizations for people with certain medical conditions, Wright said it would require the state to define comorbidities and be able to verify them. If California goes that route, it will likely need to create more subsections in its vaccine layers, further complicating an already complex system, he said.
“You can imagine a formula that takes health conditions, age, your job, your level of exposure and other factors as well, in creating some sort of score,” said Wright, explaining the difficulty. “We hope that this moment of scarcity will not last long.”
State health officials hope that other manufacturers will soon join the queue and increase supply – especially with potential vaccines that require only one dose, such as the Johnson & Johnson vaccine, which is nearing the end of its testing.
In the meantime, counties fear running out of doses, noting that they have no choice but to take it week by week, making planning extremely difficult.
“We were honestly afraid to finish this week, and then the state came up with an extra 5,100 doses … which we believe will allow us to continue until our next distribution next week,” Dr. Rais Vohra, Fresno County health official said last week. The county built a system to vaccinate many more people if only doses were available, he said.
Amid slow implementation, Dr. Otto Yang, an infectious disease specialist at UCLA Medical Center, said he was concerned that many high-risk individuals might have to wait several months to be vaccinated because they do not meet a certain age requirement.
“A healthy 65- and 60-year-old with a list of comorbidities is not the same in terms of risk,” said Yang. “It looks a little arbitrary, but I understand that you need a cut.”
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The coverage, translation and distribution of CalMatters COVID-19 are supported by generous donations from the Blue Shield of California Foundation, the California Wellness Foundation and the California Health Care Foundation.
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