In California, a huge number of doses of coronavirus vaccine are locked in cold stores. But last week, when Santa Clara County requested 100,000 doses to speed up the spread of vaccines, the state offered only a small portion of that amount: 6,000 doses.
The severance of the link between the county’s request and the state’s response highlights the biggest and most mystifying problem in the poor shuffling of immunizations in California.
California has one of the lowest levels of vaccine use in the country, with only a third of the 3 million doses delivered to the state actually given so far – leaving 2 million doses apparently stored in freezers and waiting recipients. But even with these storage doses, county officials and health care providers say they are trying to get more.
The launch of Rocky Immunization in California reflects the challenges at all levels of government.
Terrestrial health care providers are struggling with staffing and logistical challenges to administer vaccines, especially in places where they are also struggling with a surge in coronavirus cases and hospitalizations. Counties complain that the inconsistent supply of vaccines hampers their ability to reliably expand vaccinations. And the state, which doesn’t actually receive physical vaccines, but instead acts as a coordinator, is struggling to navigate the chaos in Washington.
On Friday, President-elect Joe Biden set out to vaccinate 100 million Americans in his first 100 days in office. But the same day, the Washington Post reported that a national stockpile of doses to be released by the Trump administration next week did not exist, leaving states struggling to figure out how and when their next deliveries would arrive.
Gov. Gavin Newsum said California expects “hundreds of thousands more” doses in the near future and doesn’t know if it can still count on them. “We heard about it at the same time as you,” he said of the missing stock during a news briefing on Friday.
There are some reasonable explanations for why so many vaccines are kept in stock while counties want more. Many countries say the doses they have in freezers are already planned to release patients. Or they can hold dose vials as long as they have a large group of people to inoculate at once, as temperature-sensitive vaccines must be used quickly before they expire.
Given the volatile supply of vaccines coming from the federal government, some providers may also delay some doses longer to ensure that people who receive their first dose can receive a second of the same type of vaccine.
In Contra Costa County, 72,000 doses were distributed to suppliers and only 36,000 were administered on Friday. But many of the other doses have been reported.
“The county isn’t just sitting on the other 36,000 doses,” Dr. Ori Zvieli, a deputy health official, said Friday. “We planned for thousands of people to receive these doses in the coming days and weeks.”
Similarly, about 40% of the doses the city’s health system has received have been injected in San Francisco – about 14,000 out of 34,000. The remaining 20,000 have been identified as eligible residents, including health workers, and are expected to be injected by next week.
These examples explain why some doses are stored, but it’s not clear why two-thirds of the state’s vaccine supplies aren’t used – placing the country’s largest country far behind West Virginia, the Dakota and most other states in the proportion of the population that is was vaccinated.
The state says this may be due in part to data backlogs: counties and health systems may not always report injected doses immediately. But California’s broken, complex distribution system makes it almost impossible to say where the vaccine went and how much of it was given.
California has 58 local health departments and three city health departments. In many areas, the local health department operates vaccine appointment planning systems. But private providers are also dealing with vaccinations.
In contrast, West Virginia, which vaccinates residents the fastest 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 public health reform at the Kaiser Family Foundation, which tracks state vaccination efforts. “So you rely a little less on the healthcare providers themselves, who create adequate staff alert systems.”
The state never physically receives any vaccine, a spokesman for the California Department of Public Health said. Doses go directly to county health departments and major health care providers from Pfizer, which produces one of the vaccines, or McKesson, which distributes the other vaccine produced by Moderna.
The counties place their dose orders across the state, the state passes this on to the federal government, and the federal government decides how many doses each state will distribute. The state then distributes doses to counties that supply vaccines to some local providers or take pictures at municipal clinics.
There are 3,500 healthcare providers across the country and 100,000 people who have the right to vaccinate residents, Newsom said on Friday, for the first time this level of detail has been shared with the public. But so far, only a few hundred providers have received and administered vaccines, according to the state health department.
In addition, the state has provided some transparency regarding the number of doses delivered and administered by each supplier. This makes it difficult to determine exactly where the unused doses are. Many private providers did not disclose this level of detail to the public and the information they shared was fragmented. The state said it would soon publish an online dashboard to show where vaccines are sent, how many are sent there and how many are given.
County health services provide some visibility into how many doses they receive and how many doses they administer through their public health systems, which typically serve low-income and uninsured residents.
But this is only part of the pie with vaccines: Many counties do not know how many doses go to private providers in their county, because some of these providers receive doses directly from the state. Nor do they know how many doses go to CVS and Walgreens, which vaccinate residents of nursing homes in California as part of a federal pharmacy program.
Each county reports vaccine updates in different ways and at periodic intervals, making it difficult for the public to get a clear idea of what progress has been made in the region and the state. Several Gulf counties said they had plans to develop online boards to keep the public up to date, but only Santa Clara County did so by launching a new website on Friday.
Many private suppliers say they are working on injecting doses as quickly as possible and are looking forward to a more predictable delivery. “As soon as we receive vaccines, we are actively working to get them into the hands of individuals,” Carrie Owen Plitz, president of Kaiser Permante in Northern California, told a news conference on Friday.
Santa Clara County is among the most transparent in providing data on vaccines and its reports offer perhaps the clearest picture of the country’s complex distribution system..
About 16 organizations in the county are registered in the state and provide vaccines. These include the county health system, major providers such as Kaiser, several independent hospitals, the Veterans Administration and Walgreens and CVS, as well as several small clinics.
But the county is only responsible for overseeing the administration in its own system and some health care providers, including Stanford and several local hospitals. All others receive the vaccine directly from the state or federal government, and most do not publicly disclose how many doses they have received or administered.
According to approximately 150,000 doses of vaccines that Santa Clara County can report, about half have been administered, according to public health officials. But they don’t know how many more doses are flowing into the county through other providers, no matter how many of those doses are given to people.
“Is it any wonder, given Rubet Goldberg’s invention of a vaccine, that people are confused and unsure of where the next doses will come from?” To call it confused is an understatement, “said Santa Clara County Superintendent Joe Simitian.
Kaiser and the Palo Alto Medical Foundation – which together provide care for more than half of the county’s 1.9 million residents – receive their own supplies of vaccines from the state. The county recently ordered both to provide daily reports on the doses received and administered, but this has not yet happened consistently.
Transparency and a clear understanding of where doses go are important to help public health workers understand where the difficulties are. If the counties and the state do not know which agencies are lagging behind in dosing, they have no way to intervene and improve the situation.
Public health officials are concerned that they do not have much information about the vaccination program in pharmacies, which should immunize residents of nursing homes, which are among the most vulnerable to serious illness and death from COVID-19.
These distribution chains also break down sometimes. Public health officials said they had recently given 4,000 doses to a local hospital in Kaiser, which was exhausted to vaccinate its own staff. And they have also bypassed the federal program to inoculate staff and nursing homes through CVS and Walgreens several times to vaccinate staff and residents they consider particularly at risk.
“The system is built in a way that does not provide for accountability. “Everyone has someone else to blame and that doesn’t serve us well at the moment,” Simityan said. “For the system to work, there must be simplicity and convenience. And so far we have seen a little expensive of the two. “
San Francisco Chronicle writer Trisha Tadani contributed to this report
Catherine Hoe and Erin Olday are staff writers for the San Francisco Chronicle. Email: firstname.lastname@example.org email@example.com Twitter: @Cat_Ho @erinallday