Elected officials are coming under increasing pressure to speed up the vaccination of Californians against the coronavirus, but few seem to agree on how to solve the problem.
Gov. Gavin Newsom is taking heat from all sides over California's program, which is among the slowest in the nation. The governor has promised to deliver 1 million new doses by this weekend, but it's not clear how that will happen.
The federal government on Tuesday directed states to begin administering shots to anyone over 65, untethering it in part from a tier system blamed for widespread delays. California officials quickly said they would move as soon as Wednesday to implement the new guidance.
"He said he'd vaccinate 1 million people in 10 days, so we'll see," said Joe Rodota, a political consultant and cabinet secretary to former Gov. Pete Wilson. "If he doesn't make his million mark on Sunday night, Monday is going to be extremely ugly."
In San Francisco, a skirmish broke out over whether and how to open mass vaccination sites at sporting venues and other locations. Supervisor Matt Haney criticized Mayor London Breed for not prioritizing such an effort. Officials in Oakland and San Jose are considering using professional sports facilities to ramp up vaccinations.
"Let's make this happen in SF," Haney tweeted late Monday. "It can be at Oracle, at Kezar, at many of the sites all over the city that have been used for testing. We can do this — it's time for mass, widespread distribution of this vaccine in SF and beyond, led by our Dept of Public Health."
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San Francisco is considering mass vaccination options but has not named a specific site. Breed and health director Dr. Grant Colfax said one massive site would not serve those who need the vaccine the most — homeless, uninsured or undocumented — in the first phases of a rollout. The vast majority of San Franciscans, about 95% of residents, will be able to get vaccinated through their private or public health provider, and the city will cover the remaining 5% who are homeless or uninsured.
So far, the Health Department has distributed 22,150 doses of the vaccine to San Francisco General Hospital, Laguna Honda Hospital and small community clinics, a spokesperson said Tuesday. Of those, 9,259 have been administered.
That's a higher percentage than the state overall, where 816,673 doses out of about 2.5 million doses shipped have been administered. The slower-than-expected rollout is due to a number of issues, including some health care workers declining the vaccine, unpredictable and sporadic vaccine supply and, according to the Los Angeles Times, technical problems with a software program used by the state to coordinate vaccine distribution.
The pace of giving shots at nursing homes, which in California mostly goes through a federal program with CVS and Walgreens to vaccinate residents, is particularly frustrating, said Dr. Michael Wasserman, past president of the California Association of Long-Term Care Medicine.
"There's nothing that should slow this down," Wasserman said. "There are no excuses for not vaccinating the people who live in nursing homes, assisted living facilities, group homes and the poor women of color who care for them there. That is a top priority. There should be no excuses."
California Health and Human Services Secretary Dr. Mark Ghaly said Tuesday he would announce within the next day how the new federal guidelines for people 65 and up will work here. California's vaccine rollout prioritizes health care workers and nursing home residents but has left many health care providers scrambling to find people outside of that group to take extra doses of the perishable vaccine.
"The hope is we can begin to implement (the guidance) statewide, not county by county but statewide," Ghaly said. "The first step is to have our thoughtful expert teams go through the new guidance, understand how it'll cause some changes, and put those out there to you as soon as we can."
The change could complicate vaccination efforts under way in various counties and hospital systems. But it also could accelerate vaccinations to seniors, who are at higher risk of dying from the virus.
California has one of the lowest vaccination rates in the United States, according to Centers for Disease Control and Prevention data that tracks every state. California is vaccinating residents at a rate of 2,066 per 100,000 people — much lower than West Virginia and South Dakota, which are vaccinating residents at rates of 5,766 and 5,505 per 100,000 people.
Many of the faster-moving states have relaxed their tier-based systems, said Dr. Monica Gandhi, an infectious disease physician at UCSF.
Federal health officials in December recommended that states vaccinate people by tier, based on risk. This meant that frontline health care workers and residents of nursing homes got first priority.
Some observers think California has tried to adhere too closely to its tier-based system. But loosening the rules too much could lead to chaos. Florida, for instance, opened up vaccinations to virtually everyone 65 and older, leading to long lines outside clinics. And age is not the only factor when considering one's risk of contracting or dying from the virus.
"It sure seems like from media reports things are pretty chaotic in Florida and I don't think we need any more chaos," said Janet Coffman, a professor of health policy at UCSF. "And to say we're going to do everyone over 65, first come, first serve, is not the best way to prioritize. You can have two 65-year-olds, one who's very physically fit with few chronic conditions, who really is truly at lower risk than someone else who's 65 and has multiple chronic conditions … That's going too broad."
Shifting messages are complicating the process, said Dr. Marty Fenstersheib, vaccine officer for Santa Clara County.
"Constantly changing state and federal guidance has been a major issue," Fenstersheib said. "Every other day we seem to get a different message from the state or the federal government, and then trying to figure out what it even means and how we can pivot or shift to that particular guidance."
When asked what other, faster states are doing differently, Ghaly said California, in seeking to be "really thoughtful, trying to focus on risk and exposure and equity have led to some delays in getting vaccine out into our communities."
"Certain states I know have put a great deal of effort into coming up with priority groups, watching how we keep a keen eye on equity, have been sort of in the same place where California is," he said. "We look forward with additional vaccine to accelerating and doing more in this space than we've done already."
California is poised to receive more doses from the federal government soon, as the Trump administration Tuesday also announced it will no longer hold back second doses of the vaccines and instead release nearly all available doses to states.
The state is opening mass vaccination sites in anticipation of scaling up vaccinations to the broader public in the next several weeks. In the Bay Area, the San Mateo County Event Center opened Monday to vaccinate health care workers, and will expand to other members of the public when more vaccines are available. Dodger Stadium, Petco Park, Disneyland and Cal Expo have either opened or will open soon. The Oakland Coliseum and Levi's Stadium in Santa Clara also could be used.
Staff writers Erin Allday, Trisha Thadani and Michael Williams contributed to this report.
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