Across California, a large number of doses of the coronavirus vaccine are locked up in cold rooms. But last week, when Santa Clara County asked for 100,000 doses to increase the distribution of vaccines, the state offered only a fraction of the amount: 6,000 doses.
The gap between the province’s request and the state’s response highlights the biggest and most gratifying problem in California’s highly-vaccinated vaccination: How can California simultaneously not have enough vaccine to meet demand while so many doses remain unused?
California has one of the lowest doses of vaccine in the country, with only a third of the 3 million doses transferred to the state actually given so far. Apparently 2 million doses are stored in freezers waiting for recipients. But even with the doses being saved, provincial officials and health care providers say they are scrambling to buy more.
“We are not sitting on any vaccines, they are all moving out the door,” San Francisco Mayor London Breed said Friday when she also planned to open three vaccination sites in the city. ‘We are ready to rush as long as we get the stock for it. The locations are not the problem. This is the offer. ”
California’s rocky vaccination system reflects challenges at all levels of government. Healthcare providers have struggled with staffing and logistical challenges in administering vaccines, especially in places where they are also struggling with a furious increase in cases of coronavirus and hospitalizations. Provinces have complained that inconsistent vaccine provision is hampering their ability to reliably spread vaccinations. And the state, which does not actually receive physical vaccines, but rather acts as a coordinator, has struggled to navigate through the chaos in Washington.
President Joe Biden on Friday set a goal of vaccinating 100 million Americans in his first 100 days of office. But the same day, the Washington Post reported that a national stock of doses that would be released by the Trump administration next week did not exist, making states feel like figuring out how and when their next stock would arrive.
Gavin Newsom said California would expect “hundreds of thousands” of doses in the near future, and he did not know if he could count on them. “We heard about it at the same time as you,” he told a news conference on Friday about the missing stock.
There are some reasonable explanations why so much vaccine is stored while provinces are screaming for more. Many provinces say that the doses that are in freezers are already planned to be released. Or they can keep doses until they have enough to vaccinate a large group of people at once, as the temperature-sensitive vaccines must be used quickly before they expire.
Given the inconsistent vaccine supply coming from the federal government, some providers may also hold some doses longer to ensure that people who received their first dose can get a second one of the same type of vaccine.
In Contra Costa County, 72,000 doses were given to suppliers and only 36,000 were administered as of Friday. But many of the remaining doses are offset.
“The country is not just sitting on the other 36,000 doses,” said Dr. Ori Tzvieli, the deputy health officer, said Friday. “We have planned thousands of people to receive the doses in the coming days and weeks.”
In San Francisco, about 40% of the doses the city’s health care system receives – about 14,000 out of 34,000. The remaining 20,000 have been earmarked for eligible residents, including health workers, and are expected to be injected by next week.
The examples explain why some doses are in storage, but it is not clear why two-thirds of the state’s vaccine supply was not used, making the country’s largest state far behind West Virginia, the Dakotas and most other states in the ratio of vaccinated population. The state says this may be partly due to a backlog in data reporting: provinces and health systems do not always immediately report the doses injected. But California’s broken, complicated distribution system makes it nearly impossible to determine where the vaccine went and how much of it was administered.
California has 58 local health departments and three city health departments. In many areas, the local health department has vaccine appointment systems. But private providers also handle vaccinations.
In contrast, West Virginia, which vaccinates residents at the fastest rate in the United States, has a simpler system for planning vaccinations and providing updates to the public.
“It’s a more centralized, streamlined process,” said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation. “So you’re a little less dependent on healthcare providers putting in place adequate systems to alert staff.”
The state never physically receives any vaccine, a California Department of Public Health spokesman said. The doses go directly to provincial health departments and major healthcare providers from Pfizer, which makes one of the vaccines, or McKesson, who distributes the other vaccine, made by Moderna.
Provinces place their orders for doses by the state, the state gives them to the federal government, and the federal government decides how many doses it will allocate to each state. The state then awards doses to the provinces, which deliver the vaccine to some local suppliers or give the shots at community clinics.
Worldwide, there are 3,500 healthcare providers and 100,000 individuals eligible to vaccinate residents, Newsom said Friday, the first time this detail has been shared with the public. According to the state health department, so far only a few hundred suppliers have received and administered vaccinations.
In addition, the state has provided little transparency about the number of doses delivered and administered by each provider. This makes it difficult to determine exactly where the unused doses are. Many private providers did not disclose the extent of detail to the public, and the information they shared was broken. The state said it will soon post an online dashboard to show where vaccines are being sent, how much is being sent there and how much is being administered.
Provincial health departments provide some insight into how many doses they receive and how many doses they administer through their public health systems, which usually serve low-income and uninsured residents.
But this is just one piece of the vaccine: many provinces do not know how many doses of private providers go into their country, because some of the providers get doses directly from the state. They also do not know how many doses of CVS and Walgreens will be used, which vaccinates California residents as part of a federal pharmacy program.
Each province reports vaccine updates differently and at sporadic intervals, making it difficult for the public to get a clear picture of what kind of progress is being made in the region and state. Several Bay Area counties said they plan to develop online dashboards to keep the public up to date, but only Santa Clara County has done so and launched a new website on Friday.
Many private providers say they are working to get doses injected as quickly as possible, and are eagerly awaiting a more predictable offer. “Once we receive vaccines, we are actively working to get them under individuals’ arms,” Carrie Owen Plietz, president of Kaiser Permanente, Northern California, told a news conference on Friday.
Santa Clara County is one of the more transparent providers of vaccine data, and its reports provide perhaps the clearest picture yet of the state’s complex distribution system..
About 16 organizations in the country have registered with the state and provide vaccinations. These include the provincial health system, major providers such as Kaiser, several independent hospitals, the Veterans Administration and Walgreens and CVS, along with several small clinics.
But the county is solely responsible for overseeing administration in its own system and that of certain healthcare providers, including Stanford and several local hospitals. Everyone else gets vaccinated directly from the state or federal government, and most do not report publicly how many doses they have received or administered.
According to public health officials, about half of the 150,000 vaccine doses for which Santa Clara County is responsible have been administered about half. But they do not know how many doses flow through the country to other suppliers, and let them know how many of the doses were given to humans.
‘Is it any wonder, given the Rube Goldberg offering designed for (vaccine) delivery, that people are confused and unsure about where the next doses are coming from? Calling it complicated is an understatement, “said Santa Clara County Supervisor Joe Simitian.
Kaiser and Palo Alto Medical Foundation – which together account for more than half of the province’s 1.9 million inhabitants – receive their own vaccine supply from the state. The country recently ordered them to report daily on doses received and administered, but this is not yet happening consistently.
Transparency and a precise understanding of where doses are going is important to help public health officials understand where bottlenecks occur. If provinces and the state do not know which agencies are left behind in administering doses, they cannot intervene and improve the situation.
Public health officials are concerned that they do not have much information about the vaccination program for pharmacies, which is supposed to immunize nursing home residents.
These distribution chains also sometimes break down. Public health officials said they recently gave 4,000 doses to a local Kaiser hospital that did not have enough supplies to vaccinate its own staff. And they also bypassed the federal program to vaccinate nursing home staff and residents via CVS and Walgreens to vaccinate staff and residents who they say are particularly dangerous.
‘The system is built in a way that does not offer responsibility. “Everyone has someone else to blame, and that does not serve us well at the moment,” said Simitian. ‘To make the system work, there must be simplicity and ease. And so far we have seen nothing of precious little. ”
The author of the San Francisco Chronicle staff, Trisha Thadani, contributed to this report.
Catherine Ho and Erin Allday are writers of San Francisco Chronicle staff. Email: [email protected] [email protected] Twitter: @ Kat_Ho @erinallday