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State's vaccine rollout plan comes up short for Santa Clara, San Mateo counties

Blue Shield program ignores communities most in need, local health leaders say

Clinical nurse Vilma Barbadillo vaccinates Eddie Wong, 70, with the Moderna COVID-19 vaccine at a mass vaccination site at the Mountain View Community Center on Jan. 26. Photo by Magali Gauthier.

California's new vaccine rollout program through Blue Shield is threatening to derail efforts to equitably distribute doses in Santa Clara and San Mateo counties, county health leaders told their respective boards of supervisors on Tuesday.

The state is directing 40% of vaccines for low-income and minority groups in more than 400 ZIP codes, but none of those will be going to either county's most vulnerable communities, county officials said.

Concern over the diminishing number of vaccine doses has both counties looking at ways they might opt out of the state system. Santa Clara County is planning to write state officials a letter regarding their concerns and is likely to request a withdrawal; and San Mateo County health officials are also exploring how it can leave the system run by Blue Shield.

The state's new vaccination network, which launched on March 1, contracts with the Oakland-based health insurance company to distribute the vaccines and create an online central site, myturn.ca.gov, for residents to book vaccination appointments. Blue Shield also advises the state on how the vaccines would be apportioned to target areas in the state that are most heavily affected by COVID-19. Counties would also be required to follow state guidelines for vaccine eligibility rather than make their own decisions on whether to follow the state's phase system.

County officials said the state's use of ZIP codes to determine which communities are in highest need — communities that rank poorly on the state's Healthy Places Index, which measures socioeconomic disparities — is flawed because many large metropolitan regions ZIP codes are often shared by wealthy and economically disadvantaged communities. Because of that association, areas highly affected by COVID-19 are not on the list of 400 ZIP codes the state is targeting to reduce the disparity.

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"This week, the vaccine situation has gotten precipitously worse," said Dr. Marty Fenstersheib, Santa Clara County's COVID-19 testing and vaccine program officer.

While the state's overall vaccine allocations rose this week for Pfizer-BioNTech and Moderna doses, Santa Clara County saw a drop in its vaccine allocation by more than 4,800 doses from both manufacturers. The total number of doses the county received did increase by about 3,000 due to the addition of the single-shot Johnson & Johnson vaccines (the county received 7,500 doses), but the shortage of the two-dose vaccines from Pfizer and Moderna caused the county to scramble to find vaccines for people who were due for their second dose, which is must be given roughly three to four weeks after the first injection for full immunity, Fenstersheib said.

"We needed second doses, especially Moderna. We had to work hard on the second doses and to make up for it, we had to cancel first doses and not take any more appointments," he said.

County Executive Jeff Smith said officials have "significant concerns about this process. It's a significant risk to the health and welfare of residents in our county because it's adding another layer of administration between their opportunity to get vaccinated and our opportunity to give them vaccinations," he said.

The third-party agreement between California and Blue Shield also forces the county into a new appointment system and a new way of accessing appointments through the state that would leave the county without any control, he said. Having a private insurance company collect private health data for all residents who are vaccinated is also problematic, he said.

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"It's a significant problem with confidentiality and trust because many of our residents do not trust the government to treat their information with care and security. It eliminates local control, puts our local equity efforts at risk. It means that we would not be able to operate as many small pop-ups and focused sites on particular communities," Smith said.

The county has the infrastructure in place to make it easy for residents to search its website for data on its daily updated data dashboards and to sign up for vaccines, he said. The Blue Shield contract adds layers of bureaucracy and puts "statewide priorities over local needs," he said.

Santa Clara County has a robust system for operating vaccination sites, which it would still control under the state plan, but vaccine supply has been, and continues to be, hampering their efforts.

"With respect to Santa Clara County, our impediment and our issue is purely one of vaccine supply," he said. There's no indication that in any way that (the) supply issue is addressed through the third-party administrator, Blue Shield, he said.

County Health Officer Dr. Sara Cody said she remains concerned about the vaccine shortage. Without a rapid deployment of doses, the circulating virus has more chances to mutate into more dangerous variants that could make the vaccines less effective or ineffective.

"I am quite concerned. I'm trying not to go over the top expressing it to you all, but we really are in a race between emergence of these variants and our ability to get our population vaccinated. And, as you know, we do not have control over the vaccine supply," she said.

The Board of Supervisors directed county staff to draft a letter regarding their objections, particularly the allocation by ZIP codes issue and opting out of the Blue Shield program, to be signed by the board.

County Counsel James Williams said the option to not participate in California's vaccination system is unclear and has heard different information from the state. There is hope that California will exercise its discretion to allow counties flexibility in using their own programs that are working, he said.

Williams also noted there could be a conflict of interest by contracting a core state function to a private entity, in particular to a private health insurance company that is otherwise responsible for paying claims on a vaccine that it is now determining how to distribute.

Supervisor Cindy Chavez said the state's plan impacts the county's ability to be flexible and its work with entities it has been partnering with since earlier this month. The state program would require private health providers such as Palo Alto Medical Foundation, which is part of the Sutter Health network, to use the Blue Shield distribution framework, staff also noted.

Medical assistant Monica Magana draws the Moderna COVID-19 vaccine into a syringe at Ravenswood Family Health Center in East Palo Alto on Jan. 30. Photo by Magali Gauthier.

San Mateo County officials are also examining ways to potentially exit from the Blue Shield program. On Tuesday, county Chief of Health Louise Rogers noted that none of the county's ZIP codes are in the state's 40% vaccine supply distribution to the lowest Healthy Places Index.

"We will not be receiving more supply as a result of this state policy change. Although our lowest Healthy Places Index census tracts do experience disparities, they are not in the lowest 25% of census tracts statewide. In fact, there are only 10 Bay Area ZIP codes on the list: four in Solano, three in Alameda, two in San Francisco and one in Contra Costa," she said. If California doesn't increase its stockpile of vaccines, it will result in a flattening of the supply, which is already insufficient to meet the local demand.

County health officers and legal counsel are contemplating the ramifications of possibly turning down the Blue Shield partnership, Rogers said. They are working to understand the positions of other counties including Los Angeles and Ventura, which have petitioned the state to be removed from the Blue Shield program. They cite the insurance giant's lack of on-the-ground understanding of their counties' diverse populations and needs, according to multiple news sources.

Rogers indicated the county is treading cautiously.

"Our goal is to ensure the maximum supply of the vaccine to our county" with minimal disruption, she 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.

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State's vaccine rollout plan comes up short for Santa Clara, San Mateo counties

Blue Shield program ignores communities most in need, local health leaders say

by / Palo Alto Weekly

Uploaded: Wed, Mar 10, 2021, 3:56 pm

California's new vaccine rollout program through Blue Shield is threatening to derail efforts to equitably distribute doses in Santa Clara and San Mateo counties, county health leaders told their respective boards of supervisors on Tuesday.

The state is directing 40% of vaccines for low-income and minority groups in more than 400 ZIP codes, but none of those will be going to either county's most vulnerable communities, county officials said.

Concern over the diminishing number of vaccine doses has both counties looking at ways they might opt out of the state system. Santa Clara County is planning to write state officials a letter regarding their concerns and is likely to request a withdrawal; and San Mateo County health officials are also exploring how it can leave the system run by Blue Shield.

The state's new vaccination network, which launched on March 1, contracts with the Oakland-based health insurance company to distribute the vaccines and create an online central site, myturn.ca.gov, for residents to book vaccination appointments. Blue Shield also advises the state on how the vaccines would be apportioned to target areas in the state that are most heavily affected by COVID-19. Counties would also be required to follow state guidelines for vaccine eligibility rather than make their own decisions on whether to follow the state's phase system.

County officials said the state's use of ZIP codes to determine which communities are in highest need — communities that rank poorly on the state's Healthy Places Index, which measures socioeconomic disparities — is flawed because many large metropolitan regions ZIP codes are often shared by wealthy and economically disadvantaged communities. Because of that association, areas highly affected by COVID-19 are not on the list of 400 ZIP codes the state is targeting to reduce the disparity.

"This week, the vaccine situation has gotten precipitously worse," said Dr. Marty Fenstersheib, Santa Clara County's COVID-19 testing and vaccine program officer.

While the state's overall vaccine allocations rose this week for Pfizer-BioNTech and Moderna doses, Santa Clara County saw a drop in its vaccine allocation by more than 4,800 doses from both manufacturers. The total number of doses the county received did increase by about 3,000 due to the addition of the single-shot Johnson & Johnson vaccines (the county received 7,500 doses), but the shortage of the two-dose vaccines from Pfizer and Moderna caused the county to scramble to find vaccines for people who were due for their second dose, which is must be given roughly three to four weeks after the first injection for full immunity, Fenstersheib said.

"We needed second doses, especially Moderna. We had to work hard on the second doses and to make up for it, we had to cancel first doses and not take any more appointments," he said.

County Executive Jeff Smith said officials have "significant concerns about this process. It's a significant risk to the health and welfare of residents in our county because it's adding another layer of administration between their opportunity to get vaccinated and our opportunity to give them vaccinations," he said.

The third-party agreement between California and Blue Shield also forces the county into a new appointment system and a new way of accessing appointments through the state that would leave the county without any control, he said. Having a private insurance company collect private health data for all residents who are vaccinated is also problematic, he said.

"It's a significant problem with confidentiality and trust because many of our residents do not trust the government to treat their information with care and security. It eliminates local control, puts our local equity efforts at risk. It means that we would not be able to operate as many small pop-ups and focused sites on particular communities," Smith said.

The county has the infrastructure in place to make it easy for residents to search its website for data on its daily updated data dashboards and to sign up for vaccines, he said. The Blue Shield contract adds layers of bureaucracy and puts "statewide priorities over local needs," he said.

Santa Clara County has a robust system for operating vaccination sites, which it would still control under the state plan, but vaccine supply has been, and continues to be, hampering their efforts.

"With respect to Santa Clara County, our impediment and our issue is purely one of vaccine supply," he said. There's no indication that in any way that (the) supply issue is addressed through the third-party administrator, Blue Shield, he said.

County Health Officer Dr. Sara Cody said she remains concerned about the vaccine shortage. Without a rapid deployment of doses, the circulating virus has more chances to mutate into more dangerous variants that could make the vaccines less effective or ineffective.

"I am quite concerned. I'm trying not to go over the top expressing it to you all, but we really are in a race between emergence of these variants and our ability to get our population vaccinated. And, as you know, we do not have control over the vaccine supply," she said.

The Board of Supervisors directed county staff to draft a letter regarding their objections, particularly the allocation by ZIP codes issue and opting out of the Blue Shield program, to be signed by the board.

County Counsel James Williams said the option to not participate in California's vaccination system is unclear and has heard different information from the state. There is hope that California will exercise its discretion to allow counties flexibility in using their own programs that are working, he said.

Williams also noted there could be a conflict of interest by contracting a core state function to a private entity, in particular to a private health insurance company that is otherwise responsible for paying claims on a vaccine that it is now determining how to distribute.

Supervisor Cindy Chavez said the state's plan impacts the county's ability to be flexible and its work with entities it has been partnering with since earlier this month. The state program would require private health providers such as Palo Alto Medical Foundation, which is part of the Sutter Health network, to use the Blue Shield distribution framework, staff also noted.

San Mateo County officials are also examining ways to potentially exit from the Blue Shield program. On Tuesday, county Chief of Health Louise Rogers noted that none of the county's ZIP codes are in the state's 40% vaccine supply distribution to the lowest Healthy Places Index.

"We will not be receiving more supply as a result of this state policy change. Although our lowest Healthy Places Index census tracts do experience disparities, they are not in the lowest 25% of census tracts statewide. In fact, there are only 10 Bay Area ZIP codes on the list: four in Solano, three in Alameda, two in San Francisco and one in Contra Costa," she said. If California doesn't increase its stockpile of vaccines, it will result in a flattening of the supply, which is already insufficient to meet the local demand.

County health officers and legal counsel are contemplating the ramifications of possibly turning down the Blue Shield partnership, Rogers said. They are working to understand the positions of other counties including Los Angeles and Ventura, which have petitioned the state to be removed from the Blue Shield program. They cite the insurance giant's lack of on-the-ground understanding of their counties' diverse populations and needs, according to multiple news sources.

Rogers indicated the county is treading cautiously.

"Our goal is to ensure the maximum supply of the vaccine to our county" with minimal disruption, she 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.

Comments

TimR
Registered user
Downtown North
on Mar 10, 2021 at 8:39 pm
TimR, Downtown North
Registered user
on Mar 10, 2021 at 8:39 pm

Among all states, CA ranks 42nd in percentage of distributed vaccines administered. And population size isn't only issue, as Texas and Florida (with the next largest populations), have done better.* And it looks like the situation is only getting worse in CA, with counties' rejection of Newsom's Blue Cross plan. I know how I'm voting when the recall ballot arrives, as we deserve at least the competence of Texas or Florida, don't we? If not, please, why do we deserve less?



*Web Link


Resident 1-Adobe Meadows
Registered user
Adobe-Meadow
on Mar 10, 2021 at 8:54 pm
Resident 1-Adobe Meadows, Adobe-Meadow
Registered user
on Mar 10, 2021 at 8:54 pm

This situation is out of control. I was shut out by Sutter with cancelled dates and got my first shot through another source. Now I have to worry that I will not get my second shot. When you look at the charts it shows how many potential shots they received - inventory - and how many they have given out. Big disconnect. I know people who are leaving Santa Clara County because of the discombobulation and chaos.
Part the county - and part the Governor.


Cat Mom Leonorilda
Registered user
Barron Park
on Mar 11, 2021 at 10:47 am
Cat Mom Leonorilda, Barron Park
Registered user
on Mar 11, 2021 at 10:47 am

It was a huge mistake to task a private insurance company, with its own monetary interests and discriminatory pick-and-choose policies, with running a statewide vaccine program. A huge failure. JMHO.


Online Name
Registered user
Embarcadero Oaks/Leland
on Mar 11, 2021 at 10:57 am
Online Name, Embarcadero Oaks/Leland
Registered user
on Mar 11, 2021 at 10:57 am

This whole situation has been out of control for months. The County didn't even know its site didn't work right for days until Joe Simitian told them. The amount of time and frustration wasted trying to make appointments, having appointments cancelled, finding alternative appointments, having original appointments rescheduled and then finding largely empty vaccine sites because most people didn't bother to cancel their backup appointments has been absurd.

Around 40% of Californians go to big health care providers that cross county lines and thus are outside county jurisdictions. You'd think all the various bureaucrats had heard of the big state-wide providers like Kaiser, Sutter, Stanford etc. and allocate supplies accordingly.


Resident 1-Adobe Meadows
Registered user
Adobe-Meadow
on Mar 11, 2021 at 11:05 am
Resident 1-Adobe Meadows, Adobe-Meadow
Registered user
on Mar 11, 2021 at 11:05 am

Some of the biggest state taxpayers are located in these counties. And yet we are the victims of the state and Blue Shield. Why do our county representatives allow this to happen? Worse - the categories were broken down by Sutter, Kaiser, other large hospital companies. We got limited by our hospital provider. Any one who is responsible for this is going to get voted OUT.


Forever Name
Registered user
Another Palo Alto neighborhood
on Mar 11, 2021 at 1:11 pm
Forever Name, Another Palo Alto neighborhood
Registered user
on Mar 11, 2021 at 1:11 pm

#recallnewsom

What a total disaster.


Mondoman
Registered user
Green Acres
on Mar 11, 2021 at 7:25 pm
Mondoman, Green Acres
Registered user
on Mar 11, 2021 at 7:25 pm

@R1 Regarding the 2nd (booster) shot for a vaccine, the key is that it is given at least 3-4 weeks after the initial dose. That's because it takes a few weeks for your immune system to get through the various steps of creating molecules (e.g. antibodies) targeted at the invader (vaccine). It's only after those molecules are circulating that a booster dose will have its desired effect of strongly stimulating increased production of even better-targeted versions of those molecules.
This process will still work fine 6 weeks, 8 weeks or even longer after the original shot.


Anonymous
Registered user
Duveneck/St. Francis
on Mar 11, 2021 at 10:57 pm
Anonymous, Duveneck/St. Francis
Registered user
on Mar 11, 2021 at 10:57 pm

Please read the Washington Post article today, March 11, 2021 by Anne Gearan and Miriam Berger, “Biden faces pressure to distribute vaccines worldwide,” Find on Apple News.

This is serious: U.S. is now considering donating vaccines *before* we Americans have been vaccinated.
Be clear - this is NOT after us hapless, neglected older middle aged have been vaccinated! Some of us millions may be put even farther back!
I have today emailed President Biden to oppose this serious proposal (it’s about U.S.image in the world), as well as Senator Feinstein and Congresswoman Eshoo, asking them to contact Biden Administration to oppose this outrageous idea.

Who IS our second senator!?

California has ageist vaccine policy while age is the clear risk.
Vaccines primarily protect those vaccinated.
Young persons may test positive but most don’t fall ill. MANY young persons have been and are being vaccinated ahead of us in our early sixties!
Everyone is stepping before the quite high risk group 50-64 (who after 65+ should be vaccinated).
We are placed in “16-64,” the last priority group in California, a very wide age group.
This is not following the Science.

50-64 are at much higher risk of illness, hospitalization, ICU bed usage and death than younger ages. Yet we are overlooked.
And now, our vaccines may be donated overseas.
Please read the article and contact your government representatives as soon as you can. If you know other influential petsons, please help.
Biden already turned down President of Mexico who requested vaccines...we think. The article above takes new proposals seriously while noting such a tion won’t be popular among those of us whomremain unvaccinated in a situation of scarcity.


Janna
Registered user
Adobe-Meadow
on Mar 13, 2021 at 4:31 am
Janna, Adobe-Meadow
Registered user
on Mar 13, 2021 at 4:31 am
Sam Dalton
Registered user
Another Palo Alto neighborhood
on Mar 13, 2021 at 6:58 am
Sam Dalton, Another Palo Alto neighborhood
Registered user
on Mar 13, 2021 at 6:58 am

>>The state is directing 40% of vaccines for low-income and minority groups...

This sounds reasonable since there are more poor people than wealthy ones in CA and minority groups always get the short end of the stick.

Since there is a higher % of Covid-19 cases among these groups, they deserve certain priorities.

The other more well-to-do recipients will just have to wait their turn.


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