Why California's vaccine roll-out has been such a mess

The current surge and an underfunded public health system created a storm of disarray

By Nicole Karlis

Published January 23, 2021 2:00PM (EST)

Staff and volunteers distribute the COVID-19 vaccine to people as they remain in their vehicles at The Forum in Inglewood Tuesday. The Forum is one of five mass-vaccination sites that opened Tuesday in Los Angeles county. (Al Seib / Los Angeles Times via Getty Images)
Staff and volunteers distribute the COVID-19 vaccine to people as they remain in their vehicles at The Forum in Inglewood Tuesday. The Forum is one of five mass-vaccination sites that opened Tuesday in Los Angeles county. (Al Seib / Los Angeles Times via Getty Images)

When California first received doses of the Pfizer/BioNTech coronavirus vaccine in mid-December, hospitals rushed to administer them to their frontline workers. Next in line were long-term residential workers. But a month later, the state is experiencing a disconcerting lag, and vaccines aren't getting in arms as they should.

According to data by the Centers for Disease Control and Prevention (CDC) analyzed by Bloomberg, as of January 22 the state had only administered 37.3 percent of the 4,379,500 doses it received. California's percentage of doses administered is the lowest in the country. It is followed by Minnesota, Virginia, Alabama, Nevada and Kansas. (Jurisdictions with the highest percentage of doses administered include North Dakota, District of Columbia, West Virginia, New Mexico, and South Dakota.)

At the beginning of the pandemic, California was hailed for successfully flattening the curve. Only in the last couple months has the state's biggest cities experienced a surge in COVID-19 cases. With this in mind, many are wondering why has the vaccine roll-out been such a mess? And what's behind the discrepancy of vaccines obtained and vaccinations administered?

Experts have a few theories. Some say it's a result of the state's decentralized public health system, like Dr. Peter Chin-Hong, an infectious disease specialist and professor of medicine at the University of California, San Francisco.

"Part of the problem is that of course California is the most populous state, and because of that, it really reflects not being a national health system or state health system," Chin-Hong said. "What you find is a bunch of duplications, redundancies or gaps — you could be a nurse for example and get an offer to get a vaccine in a nursing home if you work there, but if you also work in the hospital, you'll also get an invitation."

Chin-Hong said some healthcare workers are getting "multiple invitations," while others aren't getting invitations at all—and that's just healthcare workers. For parts of the general population, like those over the age of 65 who Governor Gavin Newsom said were eligible for the vaccine effective immediately last week, it is even more difficult to obtain a vaccine for other reasons — namely, a lack of vaccinators.

"California is leading the nation in a surge for COVID right now, particularly in Southern California, and that makes healthcare workers who would normally administer the vaccines in short supply," Chin-Hong said. "And enlisting an army of volunteers hasn't been as smooth as one would think around that."

Finally, Chin-Hong said there's been a lack of transparency between the state, healthcare workers, and the public around what's happening.

"Nobody really understands why we have such a discrepancy in terms of how many doses have been allocated and how many actually reached into the arms of people in California," he said, noting that there is some variation within this sentiment.

In Long Beach, for example, food workers are getting vaccinated; teachers are already next in line. Meanwhile, in the San Francisco Bay Area, 90,000 frontline healthcare workers are eligible to get the vaccine as part of the first phase (Phase 1a) of vaccinations. According to San Francisco's new vaccine tracker, 48,658 doses have been administered in San Francisco— but not everyone who received one lives in San Francisco (they could work at a healthcare setting in the city). Only an estimated 31,189 eligible San Franciscans have received at least one dose of the vaccine. Technically, those who are 65 and over are eligible to get vaccinated, but they are officially part of Phase 1b.

San Francisco Supervisor Matt Haney said that, until this week, there has been a "lack of transparency" and a "lot of confusion."

"We are making some progress this week, but before Tuesday there wasn't even a place to sign up to yet, and that's as basic as it gets," Haney said. "I think local and state governments are going to want to blame everything on supply, and I think supply is definitely a reason why we can't give the vaccine to everyone tomorrow as much as we would like to. But the lack of supply is not an excuse for poor communication or no communication at all, and a lack of transparency and a lack of real responsibility for widespread distribution."

Haney said, notably, local governments that appeared to be prepared are getting their vaccines in people's arms.

Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security, told Salon that when it comes to states being effective in administering available vaccines, preparedness has been key. And unlike in cities like San Francisco, it's the states with more rural populations that appear to have their act together, because they put together plans in advance. As reported by Reuters, West Virginia opted for a "hyper-local" approach, partnering with independent pharmacies. By the end of last month, the state had already offered the vaccine to all of its congregant-care residents. Notably, West Virginia opted out of a distribution partnership between the federal government and CVS and Walgreens.

"I think it was a really proactive approach that started long before the vaccine was available that allowed some of those states to move much faster," Adalja said. "West Virginia is a state where paradoxically many people think it's poorly resourced — and because of that I think they were very proactive."

Adalja said that it's possible many bigger states were waiting for federal support, yet that funding didn't get passed until Christmas weekend.

"I think it really has to do with proactivity, but much of the fault doesn't lie necessarily with the state, it does lie mostly with the federal government for kind of not putting enough time into this last mile of vaccination and really just assuming that once the vaccine was delivered, that everything would just smooth wouldn't run smoothly," Adalja said, noting that the COVID-19 vaccine can't be administered "on the fly" like the flu vaccine.

Californians are now hopeful that a change in guard will bring a sigh of relief. On Thursday, President Joe Biden released a national plan to expedite the process.

Dr. Chin-Hong said that a national strategy will definitely help, particularly considering it's the first time that the country has had one. But he fears the confusion in California is also a symptom of public health being consistently underfunded for years.

"Public health has been defunded for many years, so you can't put on a Broadway show overnight," he said.

Nicole Karlis

Nicole Karlis is a senior writer at Salon. Tweet her @nicolekarlis.

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