Across California, a large number of doses of coronavirus vaccines are locked in cold stores. But last week, when Santa Clara County ordered 100,000 doses to increase the distribution of the vaccine, the state offered only a fraction of that amount: 6,000 doses.
The disconnect between the county’s request and the state’s response highlights the biggest and most mysterious problem in implementing California’s sloppy immunization: how can California not simultaneously have enough vaccine to meet demand while so many doses remain unused?
California has one of the lowest vaccine administration rates in the country, with only a third of the 3 million doses actually delivered to the state so far – leaving 2 million doses apparently stored in freezers and waiting for containers. But even with those doses stored, county officials and health professionals say they are struggling to get more.
“We are not sitting with any vaccines, they are all coming out the door,” said San Francisco Mayor London Breed on Friday, when she also announced plans to open three mass vaccination stations in the city. “We are ready to grow, as long as we receive the supply for that. Locations are not the problem. It’s the supply. “
The difficult launch of immunization in California reflects challenges at all levels of government. Local health service providers have faced logistical and personnel challenges to administer vaccines, especially in places where they also face a violent increase in coronavirus cases and hospitalizations. Counties have complained that inconsistent vaccine delivery impairs their ability to reliably expand vaccinations. And the state, which does not actually receive physical vaccines but acts as a coordinator, has struggled to navigate the chaos in Washington.
On Friday, President-elect Joe Biden set a goal to vaccinate 100 million Americans in his first 100 days in office. But that same day, the Washington Post reported that there is no national stockpile of doses to be released next week by the Trump administration, leaving states clumsy to figure out how and when their next supplies would arrive.
Governor Gavin Newsom said that California expected “hundreds of thousands” more doses in the near future and he did not know if he could still count on them. “We heard about it at the same time as you,” he said of the missing stock during a news conference on Friday.
There are some reasonable explanations as to why so many vaccines are stored while counties are clamoring for more. Many counties say the doses they have in freezers have already been scheduled to be distributed. Or they can withhold doses until they have enough to vaccinate a large group of people at once, since temperature-sensitive vaccines must be used quickly before they expire.
Given the inconsistent supply of vaccine from the federal government, some providers may also retain certain doses for longer to ensure that people who receive their first dose can receive a second dose of the same type of vaccine.
In Contra Costa County, 72,000 doses were allocated to providers and only 36,000 were administered until Friday. But many of the remaining doses were counted.
“The county is not just sitting on the other 36,000 doses,” said Dr. Ori Tzvieli, the deputy health officer, on Friday. “We have scheduled thousands of people to receive these doses in the coming days and weeks.”
Likewise, in San Francisco, about 40% of the doses that the city’s health care system received – about 14,000 out of 34,000 – were injected. The remaining 20,000 have been designated for eligible residents, including healthcare professionals, and are due to be injected within the next week.
These examples explain why some doses are stored, but it is not clear why two-thirds of the state’s vaccine stock has not been used – placing the nation’s largest state far behind West Virginia, Dakotas and most other states in the proportion of vaccinated population. The state says this may be partly due to the delay in the release of data: counties and health systems do not always report injections immediately. But California’s fractured and complicated delivery system makes it almost impossible to say where the vaccine went and how much was given.
California has 58 local health departments and three municipal health departments. In many areas, the local health department runs vaccine scheduling systems. But private providers also administer vaccines.
On the other hand, West Virginia, which is vaccinating residents at the fastest rate in the United States, has a simpler system for scheduling vaccinations and providing updates to the public.
“It’s a more centralized and streamlined process,” said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation, who monitors the state’s vaccination efforts. “So, you depend a little less on the health care providers themselves to set up adequate systems to alert staff.”
The state never receives any vaccine physically, said a spokesman for the California Department of Public Health. The doses go straight to the county health departments and major health providers at Pfizer, which makes one of the vaccines, or McKesson, who distributes the other vaccine, made by Moderna.
Counties place their dose orders through the state, the state passes this on to the federal government, and the federal government decides how many doses to allocate for each state. The state then allocates doses to counties, which deliver the vaccine to some local providers or administer the vaccines at community clinics.
Across the state, there are 3,500 health care providers and 100,000 individuals eligible to vaccinate residents, Newsom said on Friday, the first time this level of detail has been shared with the public. But only several hundred providers have received and administered vaccines so far, according to the state health department.
In addition, the state provided little transparency about the number of doses delivered and administered by each provider. This makes it difficult to identify exactly where the unused doses are. Many private providers did not disclose this level of detail to the public, and the information they shared was fragmented. The state said it will soon post an online panel to show where vaccines are being sent, how many are sent there and how many are administered.
County health departments are providing some visibility into how many doses they are receiving and how many doses they are administering through their public health systems, which generally serve low-income and uninsured residents.
But this is just a slice of the vaccine pie: many counties don’t know how many doses are going to private providers in their county because some of those providers are receiving doses directly from the state. They also don’t know how many doses go to CVS and Walgreens, which are vaccinating California nursing home residents as part of a federal pharmacy program.
Each county reports vaccine updates differently and at sporadic intervals, making it difficult for the public to get a clear picture of the type of progress being made in the region and the state. Several counties in the Bay Area said they have plans to develop online billboards to keep the public up to date, but only Santa Clara County has done so by launching a new website on Friday.
Many private providers say they are working to get the doses injected as quickly as possible and eagerly awaiting a more predictable supply. “Once we receive the vaccines, we will be actively working to place them in the arms of individuals,” said Carrie Owen Plietz, president of Kaiser Permanente in Northern California, at a news conference on Friday.
Santa Clara County is among the most transparent in providing vaccine data, and its reports offer perhaps the clearest picture yet of the state’s complicated distribution system..
About 16 county organizations have registered with the state and are providing vaccines. They include the county’s health care system, major providers like Kaiser, several independent hospitals, the Veterans Administration and Walgreens and CVS, along with several small clinics.
But the county is only responsible for overseeing administration in its own system and in that of certain healthcare providers, including Stanford and several local hospitals. Everyone else receives the vaccine directly from the state or federal government, and most do not publicly report how many doses they received or administered.
Of the approximately 150,000 doses of vaccine that Santa Clara County can represent, about half has been administered, according to public health officials. But they don’t know how many more doses are flowing to the county through other providers, no matter how many of those doses were administered to people.
“Is it any wonder, given the Rube Goldberg contraption that was designed for (vaccine) application, that people are confused and uncertain about where the next doses come from? To call it complicated is an understatement, ”said Santa Clara County supervisor Joe Simitian.
Kaiser and the Palo Alto Medical Foundation – which together serve more than half of the county’s 1.9 million residents – obtain their own vaccine supply from the state. The county recently ordered them to provide daily reports on the doses received and administered, but this is still not happening consistently.
Transparency and an accurate understanding of where doses are going are important to help public health officials understand where bottlenecks are occurring. If counties and the state do not know which agencies are lagging behind in dose administration, they have no way to intervene and improve the situation.
Public health officials are concerned that they do not have much information about the pharmacy vaccination program, which allegedly immunizes nursing home residents, who are among the most vulnerable to serious illness and death from COVID-19.
These distribution chains sometimes also break. Public health officials said they recently gave 4,000 doses to a local Kaiser hospital that was short of supplies to vaccinate its own staff. And they have also circumvented the federal program to vaccinate health care workers and residents via CVS and Walgreens a few times to vaccinate employees and residents that they deem especially at risk.
“The system is built in a way that does not provide for responsibility. Everyone has someone else to blame, and that is not serving us well at this particular time, ”said Simitian. “For the system to work, there has to be simplicity and convenience. And so far we have seen very little of any of them. “
The staff writer for the San Francisco Chronicle, Trisha Thadani, contributed to this report.
Catherine Ho and Erin Allday are writers for the San Francisco Chronicle. Email: [email protected] [email protected] Twitter: @Cat_Ho @erinallday