Santa Clara County provided overdose of vaccine last month to a senior county official and dozens of other non-healthcare professionals, raising new questions about providers’ discretion to vaccinate low-priority people amid a chaotic deployment across the state.
Although Santa Clara County is not the only provider to encounter the problem, its choices are surprising in part because the county has simultaneously taken a hard line against other providers who deviate from normal protocols, recently cutting the vaccine for Hospital Bom Samaritan because he improperly vaccinated teachers in Los Gatos.
Since January 11, the county has had a written plan that explains what to do with the excess vaccine, which should be used immediately as soon as it starts to thaw. It requires first offering the vaccine to those in Phase 1A, the highest priority, followed by those 75 years of age or older, and then transporting the vaccines to the Valley Speciality Center at the VMC or Saint Louise Regional Hospital.
While counties across the state struggle to ethically administer extra daily doses in the context of a general shortage, the protocol appears to leave room for what happens next. At least twice, quick-thaw vaccines have fallen into the arms of county officials who are considered part of Phase 1B, including County Counselor James Williams and others who do not regularly meet with coronavirus patients. Some of these employees, including Williams, are also much younger than those who are now being prioritized for vaccination.
The larger group was vaccinated on December 30, almost two weeks before the county set out written rules for extra doses, when county executive Jeff Smith authorized about 45 county employees who work at the center’s emergency operations center. county to get vaccines that the county says they otherwise went to waste.
State guidelines prioritize health professionals and those who live in long-term institutions in Phase 1A, followed by those over 65, educators, food and agriculture workers and first responders in Phase 1B, of which EOC employees are part .
“By definition, these slots are not known in advance. These are not scheduled appointments – what was unique about that day was that it was a much larger number, ”said Williams, who is almost 30 years old. “Usually, we are talking about a couple, two or maybe a dozen.”
At around 4 pm on December 30, Smith said he received a call informing that Valley Medical Center employee health center had a batch of unused doses from Pfizer and no higher priority healthcare professionals nearby who needed it. With about 90 minutes left to administer the doses, Smith allowed those physically present at San Jose’s emergency operations headquarters – including Williams, administrative staff, analysts and other support staff – to receive their first doses that afternoon. Williams said he was one of the “last people in line”.
At that time, some 6,000 county health workers and support staff had been vaccinated across the county.
“There was no group of people available at the hospital, so the staff at the emergency operations center seemed reasonable to me,” said Smith. “My thinking process was, ‘Well, if there are no doctors, nurses and technologists available, we should go to the emergency services.’ “
The state’s vaccination guidelines as of December give providers some leeway to narrow the list of priorities when vaccines are about to expire or people do not show up. Health departments can “temporarily adjust prioritization” only after “intensive and appropriate efforts to reach the groups prioritized at that time”, according to the California Department of Public Health, which did not respond to a request for comment on Friday .
However, exactly how these scenarios unfold in reality has caused confusion and heated debate. Last week, the county sanctioned Bom Samaritano Hospital for offering what the hospital said was over-vaccination to teachers – also under the Phase 1B pool. The county claimed that the hospital’s actions included a “problematic” series of events in which teachers received vaccinations on future dates, not just the excess vaccine.
County workers in Phase 1B received vaccines only on the day they were made available and only preventing other options, said Smith and Williams.
Elsewhere, on January 12, Deputy Director of Emergency Management David Flamm alerted emergency operations staff, public health staff and other 1B workers to a registration link to apply for same-day appointments “approved by county leadership, “according to the email obtained by this news organization.
Flamm said on Friday that it was the only time he was asked to send such an email, and the vaccines appeared to be accessible in several places. “DO NOT ADVANCE !!!!!” the e-mail said to the recipients, adding: “If you are not able to get vaccinated today, we anticipate that there will be additional days in the coming weeks when that opportunity may arise.”
“With all the vaccination operations going on, it seems to me that there is always a small delta between those administered and cancellations, or any number of problems, so I just anticipated that it could happen again,” said Flamm.
In total, there were “at least a few” cases of 1B workers receiving vaccines in addition to the December 30 group, but with far fewer numbers, said Smith.
“We were in a situation of vaccine shortage, a challenge in interpreting state regulations, a lot of people who would like to have the vaccine – and we were trying, and still have tried, to focus initially on health professionals and first responders,” said Smith. “It is a situation of using or losing.”