California Expands Vaccine Eligibility To Millions More Residents Just As Supply Drops

Covid-19 vaccine
A vial of Covid-19 vaccine U.S. Secretary of Defense

Governor Gavin Newsom has been seeking to reassure Californians that, as more and more of them get vaccinated, there is a “bright light is at the end of the tunnel.”

But recently Marta Green, an official with the entity tapped to oversee the state’s third-party vaccine distribution administrator said, “It’s really challenging. When we look at the concrete information we have…that 3-week projection from the CDC, I hate to tell you this, it is entirely flat. There is not a single [additional] dose. Not one.”

It was a startling admission made during a live video presentation — archived here — from a little-known state entity called the Community Vaccine Advisory Committee. Green works for California Government Operations Agency, which is a state entity overseeing the Blue Shield roll out. Her assessment conforms with those from many sources around the state that there would be no great new wave of vaccinations in the near future.

Los Angeles County Public Health Director Barbara Ferrer said today that the county received its largest vaccine allocation to date last week, administering 312,000 doses. It expects to administer only about 260k doses this week due to supply issues. That, just as millions more residents are eligible.

Ferrer explained the drop is because the county will not be receiving any of the new single-dose Johnson & Johnson vaccine for the next two weeks, due to a “manufacturing and production issue.” Reuters reported that production would only resume “later in March.”

“Essentially, Johnson & Johnson gave out everything they had right away and now we’re going to be waiting a little bit until they have more to distribute,” said Ferrer. The logic of shipping every bit of the single-shot vaccine is sound: Get more people vaccinated sooner. And to be fair, the lack of J&J vaccine in the coming weeks is a nationwide issue not unique to California, with Reuters reporting that no doses of the one-shot treatment will be shipped nationwide next week. But the timing of the shortage is maddening for some Californians.

The drop in vaccine supply will coincide with the implementation today of Newsom’s decision to expand eligibility to people aged 16-65 years old with an underlying health condition. The group comprises 4.4 million Californians.

Ferrer said Wednesday that eligibility has also expanded to include custodial-janitorial workers, public transit workers and airport ground crew workers, along with social workers who handle cases of violence and abuse, and foster parents providing emergency housing for young people.

That’s after roughly 1.7 million essential workers, including teachers, became eligible for vaccines last week. Health care workers and residents aged 65 and over were already eligible. Of that 65+ cohort in L.A., Ferrer estimates that only 61% have received a first dose.

The L.A. County Public Health Director admitted today she was not even sure how many people in the county were now eligible for vaccines. “I think unfortunately we’re struggling to have a good number of people who are eligible [for vaccines] under the new guidelines from the state,” she said.

The timing of the expansion is awful. Ferrer said that, while L.A. County administered 312,000 doses last week it expects to administer only about 260k doses this week, just as millions more residents are eligible. It’s a concern echoed by county health officials across the state.

Sacramento County, Kaiser Permanente in Northern California and, two weeks ago, Sutter Health have according to the Sacramento Bee “at varying points within the vaccine rollout expressed concerns that their supply was either unacceptably low or had dropped significantly without warning or explanation from the state.”

These recent issues are not the first time — or even the fifth — that county officials have been left scrambling after projections from the state have not come to pass. In fact, when it comes to vaccine allocations, it’s a weekly thing.

In January, President Joe Biden promised to provide state and local health officials a three-week window into how many vaccine doses were on the way. While Newsom has repeatedly ticked off the state’s allotments three weeks out, local health officials who are running vaccine efforts on the ground say they are not getting that three-week window.

The embattled California Governor has moved to quickly expand the number of vaccination sites — from drug stores like CVS to super sites like those at stadiums where the Oakland A’s and San Diego Padres usually play. The number available vaccines seemed to shrink — especially in Los Angeles — as more sites were inaugurated. That has caused even more uncertainty.

“It is a little bit of Hunger Games out there,” said LA Mayor Eric Garcetti on February 10. “We’re doing kind of an ‘all the above approach.’ I think part of this is we’ve gone to so many places without the supply matching that, that you’ve seen some of the core places…like ours and the county mega sites not have as much supply.”

Garcetti also said he wasn’t clear why the city received so few doses that week.

But Newsom has repeatedly seemed quite clear how many doses would be received in the near future. He said in late February that the state would administer about 1.4 million doses in the current week, expected 1.55 million next week and 1.6 million the week after. He reportedly ran through the numbers again this week at an untelevised event.

So since the state determines county allotments from the numbers given to it by the federal government, the sticking point on the three week window seems to be at Newsom’s level.

The governor has often responded that the federal government ships vaccines directly to local healthcare providers, seemingly cutting him out of the loop. But that’s political sleight of hand. What local officials are looking for is simply the promised information: How many doses am I getting in each of the next three weeks. That is something the state has access to. In fact, the state has controlled how many doses go to each county. That’s the whole point of the Blue Shield deal: to distribute vaccine allotments more efficiently.

Why are three-week projections important? Vaccination sites need to be able to have people scheduled for a number of appointments that match the number of doses coming in. Ideally, that’s a process that happens smoothly weeks ahead of time. When it doesn’t you get examples like Dodger Stadium, which can deliver upwards of 7,000 vaccinations a day, but shut down last month because deliveries didn’t match appointments. Thus the nation’s largest vaccination site had to close its gates for two days.

“This week we only received 16,000 new doses,” said Mayor Garcetti at the time. “That’s about the number of new doses we give out every single day,” he said. “That is down 90,000 from the week before. That is unacceptable.”

Asked in late February about the lack of transparency the governor said, “Next week the counties will start getting their three-week window, specifically March 1st.” That March date was when the state’s no-bid deal with Blue Shield to allocate vaccination doses and centralize appointments was supposed to take effect. Part of the company’s mission was to create an algorithm that would parse allocations across the state.

But March 1 came and went and the Public Health Director of the state’s largest county still did not have visibility into coming vaccine shipments. “Do we know our dose allocations 3 weeks out?” asked Ferrer on March 3. “I don’t think we do.” She seemed no more sure this week.

In the past month, Newsom mandated that 10% of all vaccines be reserved for educators and 40% of the supply be held for the most economically-disadvantaged in the state. So, while he has significantly expanded the pool of those eligible, he has restricted availability of the vaccine by half — of course, there is likely overlap between cohorts.

The delta between promises made and promises kept may be Governor Newsom’s biggest challenge, both politically and practically.

Early on, there was the ruckus over a $990 million no-bid contract for masks awarded to a company called BYD. Newsom repeatedly cited the deal as an example of the state’s commitment to move quickly and decisively.

BYD was supposed to quickly manufacture highly-sought-after N95 masks at its factory in China. It was forced to refund about $250 million of the $990 million after failing to meet a deadline. Newsom then agreed to an extension last summer worth hundred of millions of dollars more to the company. Side note: BYD’s president contributed about $40,000 to Newsom’s campaign in 2018 and 2019.

Throughout the pandemic, Newsom has repeated the mantra that “data is foundational” to the state’s approach. In August however, after county officials surfaced concerns, California officials admitted that multiple errors on the state’s part had caused a backlog of 250,000-300,000 Covid-19 test records in its case data reporting system. That system was used primarily to parse and distribute coronavirus data. Weeks’ worth of numbers had to be updated.

Last fall, Newsom inaugurated “a first-in-the-nation state-run testing lab” in Valencia. The lab was unique and, at $120 million, a big bet for Newsom. But the facility’s launch was marred by an unexpectedly high number of inconclusive test results.

Another promise not met: The state had projected that it would administer 2-2.5 million vaccine doses to Californians by early January 2021. On January 4, the state had received nearly 1.3 million doses, with another 611,500 doses on their way. But only 454,306 doses had actually been administered. The governor was forced to admit, “It’s gone too slowly.”

To his credit, Newsom reacted by successfully getting the state to administer 1 million doses in 10 days.

Also in January there was the sudden loosening of Covid restrictions. The move was welcomed by Newsom critics but puzzling to some trying to follow the logic of the shutdowns. At the time, most of the state’s self-identified important Covid-19 data points were above where they were when the restrictions were implemented last fall.

And then there was the French Laundry incident. While the fact that the governor dined maskless at a posh restaurant in the weeks before he closed most eateries did not impact millions of Californians in the same way a lack of vaccines did, it became a symbol of the gap between Newsom’s words and deeds, his tendency to overpromise and underdeliver. It also became a rallying point for those now seeking to recall him.

With signatures to qualify that recall having met their target, according to organizers anyway, Newsom’s long-promised solution to the state’s vaccine appointment and distribution messes is losing steam. Local officials are not impressed by the Blue Shield-administered appointment system, dubbed MyTurn.

According to the L.A. Times, health services director for L.A. County Dr. Christina Ghaly said on Tuesday, that the My Turn system would create inefficiency. Ghaly called MyTurn a “wholly parallel and an unnecessary system,” reported the Times.

Ferrer was also concerned enough to plead, “Please don’t add a layer of complexity to healthcare providers that are already are doing a good job.”

On Wednesday Ferrer added that the governor’s $15 million solution has “created a lot of challenges. One-size-fits-all solutions are proving inadequate in providing the flexibility local communities need,” she said. Not sounding pleased to have an algorithm making decisions that impact lives and deaths, Ferrer argued that there was no need to reinvent the wheel, that there is vaccination know-how from years past. “We’ve been vaccinating people for decades.”

“Our hope is that by the time we get to the end of March, the system will work for everyone,” she continued. Some regions aren’t that patient.

Counties were supposed to begin transitioning to the Blue Shield-run MyTurn system in the first week of March. Riverside, Fresno, Imperial, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus and Tulare counties were chosen as the first to join the system. The next wave includes L.A., Orange, San Bernardino and Ventura counties. The San Jose Mercury News reported Tuesday that, according to officials from Blue Shield and the state, only one of the state’s counties — Kern — has signed a contract with Blue Shield.

The Mercury News also reported that one of California’s largest counties will not take part in the new distribution system run by Blue Shield. “I think everyone sees it as a solution looking for a problem,” said Santa Clara County Executive Jeff Smith. “We’re talking about adding bureaucracies rather than vaccinating people.”

On Friday, Blue Shield officials told the state’s Community Vaccine Advisory Committee that contracts with counties were being finalized, according to the L.A. Times.

On Wednesday, the Mercury News reported a shift: Blue Shield sent a letter telling Santa Clara County officials to “disregard” the contract it previously sent for review.

Ventura and Los Angeles counties have also requested to opt out of the Blue Shield-run system, according to the Times. San Joaquin County is exploring other options as well. Tiny Lassen County simply just announced its own system and is running with it.

Newsom vigorously defended the state’s distribution system in Tuesday’s state of the state address from Dodger Stadium, now a mass vaccination site. The governor said California has “the most robust vaccination program in the country” but added: “I know our progress hasn’t always felt fast enough.” That’s especially when a larger demand is met with a diminished supply.

“We are not seeing significant increase in supply, other than the one-time increase of the new Jannsen or Johnson and Johnson…the new vaccine. We have a one-time bump coming in,” said Green at the most recent Community Vaccine Advisory Committee meeting. After that increase, she said, supply is flat: “There’s no Johnson & Johnson, none, in the outlying weeks.”

Green continued by observing that, with the decision to make millions more Californians eligible today, “What we are going to feel is a decrease over the next 3 weeks. Supply is going to feel more constrained. And that is just, for me, it’s cognitive dissonance: having this public conversation about the increase in supply and the strong push to get everyone vaccinated, but in the short term what we have is this 3 week projection that is flat. What I’m hoping is that, when those allocations actually come, is that [they’re] over that projection, that it’s an under-promising and over-delivering, but all we have right now is that 3 week projection now from the CDC.

Dr. Bonnie Pan the state’s epidemiologist said “I would echo that…Hopefully we’ll see more of the actual numbers are and what that [J&J] partnership with Merck is and how that’s going to increase [supply]. But in the short term it’s true, I think we’re in a hard spot now.”

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