One month after the first doses of a COVID-19 vaccine arrived in Santa Clara County, county leaders are hurrying to fix shortcomings in the rollout system, plan for thousands more vaccinations per day and get as many doses as they can from the state to meet the demand.

Administering the vaccines has been a patchwork effort, with the state sending doses directly to some large health care systems — such as Sutter Health/Palo Alto Medical Foundation and Kaiser — separately from the doses it's sending to the county. Meanwhile, federal vaccine supplies are being delivered to agencies such as the Veterans Affairs Palo Alto Health Care System as well as to CVS and Walgreens, which are handling vaccinations in senior care facilities.

Unfortunately, the federal government is not disclosing the numbers of doses it's delivered to agencies within Santa Clara County, nor is the state sharing its numbers, county leaders told the Board of Supervisors on Tuesday. So no one really knows the collective number of doses that has arrived in the county or has been administered at this point.

Given this, Santa Clara County Supervisors on Tuesday passed 5-0 a proposal from Joe Simitian and Cindy Chavez to require large health care systems to produce written plans and timelines for COVID-19 vaccine distribution.

"I know it's a big lift to collect and coordinate these plans, but the public shouldn't be sitting around wondering when and where they can be vaccinated as they were with testing," Simitian said. "And time is of the essence. We can't afford to lose a month; we can't afford to lose a week; we can't afford to lose a single day."

In tandem with the two supervisors' proposal, the county's Public Health Department issued a public health order on Jan. 7 that requires Kaiser, Sutter Health/PAMF, Stanford and the county itself to provide information on an ongoing basis with the public and to submit vaccination plans by Feb. 1.

Kaiser and Sutter Health/PAMF alone serve about half of the county's 2 million residents.

The comprehensive plans must include: how the health care provider intends to provide vaccines to all of its primary care patients as they become eligible; how it will create vaccine-administration sites; communication plans to inform its patients when and where they can receive vaccines; the anticipated number of vaccine appointments; and a timeline for achieving the full vaccination of its patients and how it will avoid "wasting" vaccine doses when there are not enough patients receiving them within a designated tier on any particular day.

Board members Tuesday agreed with Simitian and Chavez that detailed and publicly disclosed plans and timelines can reduce confusion, instill confidence, and, most importantly, get the job done in a timely, fair, efficient, and life-saving fashion.

"Ensuring we have a coordinated, comprehensive and transparent set of plans reduces the chance for anyone to get left behind," Simitian said. "Our only chance of success is a set of clearly defined plans designed to complement one another, and to cover the entire county."

As of Jan. 12, the county Department of Public Health and other health care providers had vaccinated 52,316 people with a first dose, using 47% of the 110,000 first doses of vaccines received, according to the county's presentation to the board. That figure includes Kaiser, Stanford Health Care and El Camino Hospital among others, but not Sutter Health/PAMF or the federally supported vaccination programs. An additional 56,620 doses have been received in the county for the second shots.

This week, County Executive Jeff Smith also unveiled plans to launch a vaccination dashboard, similar to the county's COVID-19 dashboard, that will summarize the information provided by all of the vaccine providers.

Smith also detailed county plans for ramping up to provide mass vaccinations on the order of 10,000 to 20,000 shots a day. That's a huge expansion from the county's current rate, which was 800 a day on Jan. 1 and 3,600 a day as of Jan. 12, with plans to increase to 6,975 a day by Jan. 18 — provided the county receives more vaccine doses from the state.

One of those vaccination sites will be Mountain View Community Center, which will offer 1,000 inoculations a day and come online by the end of next week, Smith said. The county also expects to launch a mobile vaccination clinic to serve hard-hit areas.

But the rubber will meet the road when the county identifies a site that can handle more than 10,000 shots a day — an indoor space with sufficient parking, he told the supervisors on Tuesday. San Francisco 49ers President Al Guido sent a letter to the board offering Levi's Stadium as a "facility with the requisite technology to store vaccines, world class security, and the capability to partner with public health professionals to administer vaccines."

Despite the planning, Smith expressed significant concern that the county will be ready to give out shots but will not have the doses on hand.

County officials submitted a request to the state on Sunday asking for 100,000 more doses.

"We were told today we'd get 6,000 doses. That's not enough," he told the supervisors.

"As I pointed out, we have lots of physical capacity and not as much vaccine as we need," he said. "We do feel we made a valiant effort to do all of the vaccinations for the phase 1A class, and so at this point, if we get adequate vaccine, which is a big if, we're considering moving along the tier system, pursuant to new direction from the state, as rapidly as we can. We are planning for ... expanded access if — big, huge if — we get enough vaccine."

"We'll be pushing the state to give us more," he added.

Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.