California health officials are now releasing the guidelines on who can be vaccinated against the coronavirus, which could potentially accelerate the rate of vaccinations, while also opening the door to ethical and logistical questions about how to do it in a fair and orderly manner. .
The move came as public health experts and others were debating how to get more ‘gunshots’ in California and across the country, as vaccinations this week continued to decline and an increase in cases and deaths threatened to overwhelm hospitals.
The presidential election team of President Joe Biden said on Friday that he would release almost all available vaccine doses after taking office on January 20, ending the current federal strategy to withhold half of the doses to ensure that people can get the second chance later. The announcement of the plan “to ensure that the Americans who need it get it as soon as possible” comes after a group of governors, including Gavin Newsom, in California, pleaded with federal officials to release more vaccines .
However, it was not clear how delivering more doses to states could solve the problem, as they could not get the doses they had received so far into their arms.
California administered just over 652,000 doses of vaccine, about 32% of the approximately 2.1 million doses it received.
The California Department of Public Health on Thursday issued recommendations that allow local health departments and health care providers to vaccinate all health workers in the first group, known as Phase 1a, instead of vaccinating according to the risk of exposure to the workers. The recommendation also allows local health departments and providers to start vaccinating residents in the next group, Phase 1b – a much larger group of essential workers and the elderly – as long as they have already made vaccines available to everyone in Phase 1a who wants one. . It may help to alleviate the problem of unused doses if some health professionals do not want to be vaccinated.
Newsom said Friday the new guidelines give healthcare providers more ‘common sense’ discretion to offer extra doses to a parent, for example, if someone has decided not to take it, or if not enough people show up to be vaccinated.
“We will see administration faster,” Newsom said. “You’ll see it.”
Santa Clara County officials said Friday they will begin implementing the recommendations.
“In the last 48 hours, we (the state) have received confirmation that we can offer vaccination in phase 1a,” said Santa Clara, public health officer, dr. Sara Cody, said during a news conference. “Before, we moved level by level, which makes it more complicated. So I think now we will be able to go faster, and that’s ideal for everyone. ”
Phase 1a contains three levels of health workers, according to the risk of being exposed to COVID-19. The first level includes people working in acute care hospitals and nursing homes, the second is people working in emergency care and primary care clinics, and the third includes dentists and pharmacists.
“We’re trying to get through 1a as fast as we can,” Cody said. “Once we are confident that people who are eligible for Phase 1a have access to their appointment and have made their appointment, we can move on to Phase 1b.”
The state that allows Phase 1b to start may be able to move forward where Bay Area provinces and healthcare providers are currently, as most are still expecting Phase 1a vaccination and not by the start of Phase 1b until the end of January or early February. But it gives local health officials the opportunity to move on to the next group after offering the vaccine to all the health workers who want it.
“We can not allow the perfect to be the enemy of the good,” says Dr. Art Reingold, a professor at the UC Berkeley School of Public Health and co-chair of the state committee that assesses coronavirus vaccinations for safety and efficacy. The question: ‘When is it OK if you have not yet completed one phase to start offering vaccine to people in other phases? ‘is complicated. But it is important for us to do so as long as we do not run out of the vaccine for high-priority groups for earlier stages. ”
The state has not yet determined who will be in phase 1b, but it will likely include 15 million essential workers and older residents. The first phase of the phase is likely to be 8.5 million teachers and childcare workers, food and agricultural workers, emergency service workers and people aged 75 and over. The second level is 6.5 million transport and critical infrastructure workers, and people aged 65 to 74, and imprisoned and homeless residents. It is unclear whether both levels will be vaccinated simultaneously, or that providers will need to be in order.
As vaccines become available to more people, it opens the door to many more logistical and ethical questions. The initial deployment was already rocky and fragmented, and moving quickly to the next, much larger groups could mean it would become even more difficult. In Phase 1a, people are usually vaccinated by their health care employer, provincial health department or a federal pharmacy program. Phase 1b will be more complicated.
For example, will a teacher be vaccinated by the school district where they work, their own healthcare provider or the country where they live? Will vaccines ask for identification to check people’s age or proof of their profession, or will they rely on the honor system?
And how to prioritize who should go next is discussed. Dr. Bob Wachter, chairman of the UCSF Department of Medicine, suggested that once all health workers and people over the age of 55 are vaccinated, a lottery system will determine when the remaining millions of Americans will be vaccinated.
For the past two weeks, the distribution of vaccines in several top healthcare systems – which enjoy world-class computer systems and robust human resources departments that can track their employees – has led to line jumps, fraud and noisy protests over who is first. , ”The dr. Ashish Jha, Wachter and Brown University, wrote in a New York Times opinion piece on Thursday. ‘If it’s complicated to vaccinate a few thousand health workers, we can only think of the chaos that lies ahead as we try to vaccinate a few hundred million Americans. … Few people will like the idea, but it will be fair and apolitical, and people will know that their number will be called somewhere in the next few months. ”
Catherine Ho is a staff writer for the San Francisco Chronicle. Email: [email protected] Twitter: @ Kat_Ho