The next tier of COVID-19 vaccines, Phase 1B Tier 1, could come "very soon, as supply increases over the next few weeks," Dr. Robert Schechter, co-chair of California's Drafting Guidelines Workgroup, said on Wednesday, Jan. 6.
Schechter made the statement, somewhat reluctantly, during a meeting of the Community Vaccine Advisory Committee after being pressed to provide a more definitive estimate for when the next phase of vaccines might roll out. But before that happens, front-line health care workers and residents at long-term care facilities who are in the Phase 1A groups will need to have completed their vaccinations, which require two injections about three weeks apart. The state has administered only about one-third of the 1.3 million vaccines it has as of Jan. 3, Gov. Gavin Newson said.
Looking forward, the Drafting Guidelines Workgroup and the Community Vaccine Advisory Committee are preparing for who will receive the shots and how to make sure they are administered equitably. They face a dizzying array of research, decisions and logistics that must be adjusted to each new group as the vaccines roll out.
The next phase, 1B, would be split into two tiers. Tier 1 would focus on people ages 75 and older, and workers in education, child care, emergency services, food and agriculture. Phase 1B Tier 2 would include older adults ages 65-plus; workers in transportation and logistics; industrial, residential and commercial sheltering facilities and services; critical manufacturing; incarcerated individuals and homeless people.
A third group, Phase 1C, would include people ages 50 and older, 16- to 49-year-olds with underlying medical conditions and/or a disability; workers in water and waste management; defense; energy; communication and IT; financial services; chemicals and hazardous materials; government operations and community service.
Who is eligible for the vaccines within each sector is long and complicated. Among essential workers, personal care assistants and attendants are in the health care sector and qualify for vaccines under Phase 1A, the same phase as physicians. Farmworkers qualify under Phase 1B, Tier 1, under the food and agriculture sector, an essential need. Food and agriculture sector includes production, processing, and delivery systems that feed people and animals in the United States and overseas and also those who import many ingredients and finished products, a complex web of growers, processors, suppliers, transporters, distributors, and consumers.
"This sector is critical to maintaining and securing our food supply," the state explained on its webpage of essential critical infrastructure. The California Department of Public Health also has posted sub-priorities within each tier here.
But there are also considerations for equity. Throughout the vaccine advisory committee's meeting, participants emphasized the importance of ensuring the vaccines are distributed to vulnerable communities of color. The committee is considering ways to measure the vaccination rates by potentially comparing the percent of the eligible population vaccinated in vulnerable communities to the percent vaccinated in less vulnerable communities within counties, using the California Healthy Places Index, an online resource that displays community conditions that predict life expectancy and influence health.
Launched by the Public Health Alliance of Southern California, the index also has an interactive COVID-19 resource map. The map compares characteristics of vulnerable populations by race, ethnicity and health factors including environmental exposure to COVID-19 impacts within counties. It can be used to identify which populations might need more targeted vaccinations or be prioritized.
As of Jan. 6, Santa Clara County had disproportionately high death rates among Black, Latino and Native Hawaiian/Pacific Islanders per 100,000 population, the map shows. In San Mateo County, deaths among Native American/Alaskan Native populations skyrocketed above all other groups per 100,000 of population with Native Hawaiian/Pacific Islanders and Blacks following, according to the index map.
Determining when to move to another vaccination tier is a complex web of evaluating progress and the success rate of receiving, planning and coordinating doses, their distribution and administration, Dr. Eric Sergienko, health officer for the Mariposa County Health and Human Services Agency, said during the meeting. When to move to another tier will be determined through feedback from vaccinators. Health officials will ask whether more vaccines are needed for the current tiers and if there is new demand from previous tiers, he said.
"If not, it's time to think about moving into the next tier," he said. Health officials must also coordinate with state and adjacent local health jurisdictions, look at obtaining additional doses and coordinate with vaccinators to order the new doses, he said.
Health officials also must clear several hurdles with the public to ensure that as many people will be vaccinated as possible. Jake Snow, technology and civil liberties attorney at the American Civil Liberties Union of Northern California, noted during the vaccination advisory committee meeting that there were some reports of people being asked to provide their Social Security numbers on vaccine paperwork.
"Some people might be hesitant to get the vaccine if they are required to give a Social Security number," he said.
Health leaders must also work to dispel myths about the vaccines. One participant said she was told that the vaccine would sterilize people (it doesn't). People also need to understand they will still need to wear masks even after they receive the vaccine as they could carry the virus to others even if they are immune, they said.
Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.