What's behind California’s lagging vaccine rollout

The federal distribution effort has been a decentralized mess

Published January 14, 2021 4:59AM (EST)

Coronavirus vaccine vials in hospital  (Getty Images)
Coronavirus vaccine vials in hospital (Getty Images)

This article originally appeared on Capital & Main.

It's almost too easy to blame California's COVID woes on failed state leadership. From the constant shifts in policy to the stop-and-start business and school closings and restrictions, a malformed picture has emerged of a government flailing as it attempts to deal with a virus that is not abating – and Gov. Gavin Newsom's personal missteps have only ratcheted up the levels of frustration and outrage.

But on the subject of the vaccines themselves, let's not get it twisted: California's slow-footed rollout of potential life saving doses of medicine is the result, first and foremost, of a federal botch job of the highest order — and it very clearly mirrors what is occurring across the country.

Utah Sen. Mitt Romney's recent scathing indictment of that chaotic process laid it bare. "That comprehensive vaccination plans have not been developed at the federal level and sent to the states as models is as incomprehensible as it is inexcusable," wrote the veteran Republican lawmaker. "The current program is woefully behind despite the fact that it encompasses the two easiest populations to vaccinate: frontline workers and long-term care residents."

There was no plan. President Donald Trump essentially acknowledged as much when he tweeted, "The Federal Government has distributed the vaccines to the states. Now it is up to the states to administer. Get moving!" It was precisely the type of message that health workers and officials have come to expect from Trump – devoid of either meaning or direction – but in this case, the stakes were enormous.

In truth, the federal government had almost nothing to do with the delivery of one of the two vaccines. Pfizer handled the delivery process of its product on its own, while the Moderna vaccine was shipped in coordination with the Centers for Disease Control (CDC). The result of this one foot in, one foot out process was a decentralized mess, with vast numbers of doses arriving to hospitals and clinics on erratic schedules and needing to be stored at specific temperatures and completely used within hours of opening.

Beyond that, Pfizer vials said to contain five doses' worth of vaccine actually held enough for six or even seven doses, pharmacists discovered in December. But because the Food and Drug Administration was slow to approve use of the overage, some health providers threw out the extra vaccine because they feared breaching the FDA's emergency use guidelines that specified five doses per vial.

And absent a federal model, the process for determining how to physically distribute the vaccine – and to whom – was essentially left open for discussion. The rollout, then, has had to magically work on three levels: The federal government tells the state how many doses it will receive each week; the state decides which of its counties get the doses; and local health agencies have to coordinate their varying allotment with providers and vaccination sites so that the shipments wind up in the proper places.

This week, Newsom's administration issued what it described as a "course correct" that allows those local agencies to more broadly distribute vaccines to health care workers, essentially setting aside earlier state guidelines that would prioritize one group of such workers over another. It was part of a larger plan to loosen restrictions in the face of news that California had administered only about 35% of the 1.3 million doses it had received so far.

"My worst nightmares have been coming true over the last few weeks," Dr. Michael Wasserman told San Francisco's KGO on Wednesday. Wasserman, who sits on California's Vaccine Advisory Committee and is past president of the state's Association of Long Term Care Medicine, said there are "literally hundreds of thousands of doses out there sitting in warehouses while you have nursing home residents and staff who are waiting to be vaccinated."

It is a story repeated across the country. In Florida, Gov. Ron DeSantis' order that seniors could jump the line ahead of health care workers, in defiance of CDC recommendations, led to massive overdemand and all-night long lines in some cities. Texas Gov. Greg Abbott tweeted that "a significant portion" of his state's vaccines might be "sitting on hospital shelves as opposed to being given to vulnerable Texans." And multiple other states began adjusting priorities in an effort to get current doses administered so that new shipments could arrive.

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This is also a story of wildly mismanaged expectations. In September Trump promised that 100 million doses of the vaccine would be available by year's end, more than double the CDC's most optimistic projections. It was the usual empty rhetoric, and ultimately the administration would fall far short of its goal to vaccinate 20 million Americans before the calendar turned over. As Dr. Ashish Jha, dean of Brown University's School of Public Health, said of the Trump administration, "No plan, no money, just hope that states will figure this out."

Here in January, the states are left to hash out their own solutions, and Newsom has struggled to control California's process. In a Monday news conference, the governor said the rollout is occurring too slowly, adding, "We are working aggressively to accelerate our pace." His 2021-22 proposed budget includes $300 million to aid in the distribution of the vaccines. But Newsom has been slow to provide specifics, or even explain what an aggressive acceleration of the state's effort would look like.

Absent even a modicum of federal leadership, states like California are left with a couple of hopes. The first is President-elect Joe Biden's stated goal to get 100 million doses of the vaccines distributed within his first 100 days in office. Another possible avenue of relief is a third vaccine, made by Oxford-AstraZeneca, which already has been approved in four countries.

But with cases surging up and down the state, California is facing a monumental challenge to get the vaccines distributed as quickly and efficiently as possible. As of Jan. 12, the number of doses shipped to the state had reached 3.28 million, per the CDC. The number of people receiving their first vaccination was slightly more than 816,000 – not quite 25%. It was one final parting gift from a federal administration that bungled the COVID crisis from the start

Copyright 2021 Capital & Main

By Mark Kreidler

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California Coronavirus Covid-19 Vaccine