California’s not-so-smooth vaccine rollout

In late January, 38-year-old Bao Vo had a daily routine: Every day, the downtown Los Angeles resident logged onto Orange County Health Care’s scheduling website for COVID-19 vaccinations to check if there was a spot available for his 71-year-old mother. He checked the website when he got up in the morning, again at lunchtime, and twice more after work and before bed.

“Nothing much to report,” he told me last Tuesday. Last he checked, more than 300,000 residents in Orange County were still waiting to schedule their first vaccine appointment: “Yeah, my hopes are kind of tempered down a little bit.”

Under California’s current guidelines, healthcare workers, long-term care facility staff and residents, and state residents aged 65 or over are now eligible for vaccines. But the state’s vaccine delivery system has so far been sluggish and inefficient. So far, California has only distributed 3.3 million of its 5.7 million vaccine doses, or 58 percent—one of the nation’s slowest rollouts in COVID-19 vaccine delivery. When vaccines first began shipping out in December, Californians cheered with relief, wearied from months of lockdowns and pandemic anxiety. Now, many in the state are frustrated by an administrative logjam that has delayed what they see as a lifeboat to recovery.

How fast people get vaccinated is critical: Most experts estimate about 70 percent of the population needs to be vaccinated in order to reach herd immunity, and quick delivery may curb the spread of possibly more contagious variants of the virus.

When California Gov. Gavin Newsom first announced on Jan. 13 that California would open up eligibility for the vaccines to anyone 65 and older, Vo rejoiced. He had been closely tracking the inoculation process in the state, hoping to schedule an appointment for his mother, who’s immunocompromised and doesn’t speak English as her first language.

Instead, the result was chaos and confusion as thousands of Californians overwhelmed vaccine registration portals that weren’t able to handle the surge of users. People spent hours waiting on the phone and bungling through technical bugs, only to discover they couldn’t load the website or couldn’t get an appointment slot. Others had their appointments canceled last-minute. In one county, 3,900 appointments that went available online were booked full within 32 minutes. Even those lucky enough to get their first dose were left wondering how to schedule their second. Tempers rose: “No one was able to give us a clear answer at the distribution center,” one resident tweeted. Another tweeted in all caps: “PLEASE GIVE US CLEAR INFORMATION!”

Even local health departments were confounded. Many were still scrambling to prepare the proper supplies and hire enough staff for the next tier of vaccine recipients when the governor expanded vaccine eligibility to residents age 65 and over—that’s 6.2 million more Californians. LA County Public Health Director Barbara Ferrer pointed out that the county hadn’t even finished vaccinating front-line healthcare workers, and pleaded with state officials for more details: “We haven’t heard back from the state about vaccine availability and how it would be distributed.”

Many residents turned to social media to vent or ask for help. A group of tech workers launched their own statewide information dashboard to provide a one-stop information center amid the rapidly evolving news on California’s vaccination campaign. There, about 300 volunteers are parsing official state and county websites, calling hospitals and pharmacies, and updating a list of vaccination sites.

Los Angeles resident Matthew Jones, 33, said he gets all his vaccine-related information from Twitter. He pored through the LA County Public Health website the day Newsom opened up vaccine eligibility for those 65 or older, but he could find no official information on where to schedule his 78-year-old father for vaccinations. Instead, he found the correct link through a friend’s tweet: “That’s my main frustration. I had to scan through Twitter for an appointment, but what about the elderly who don’t use Twitter? They should be able to find it on their own.”

Jones was finally able to schedule an appointment for his father on Jan. 20. His mother drove his father to get vaccinated, then called Jones, dismayed: She couldn’t understand why she, a 64-year-old caretaker to her husband, couldn’t also receive the vaccine at the same time.

Newsom has blamed the former Trump administration for his state’s rocky rollout, saying he’s gotten little clarity on vaccine supply from the federal government. Other major hospital officials in the state also pointed fingers at the Trump administration, saying there’s been no transparency in terms of how many vaccines are available, how many have been shipped, or when and how they’ll arrive.

It is true the federal government has issued little guidance to states since the beginning of the pandemic. The U.S. Centers for Disease Control and Prevention issued recommendations for vaccine priority, but let states figure out on their own how to distribute vaccines. Still, that doesn’t account for how states such as North Dakota, West Virginia, and New Mexico have been able to so quickly administer vaccine doses to their populations. Besides, now that the Biden administration is in charge, California leaders can no longer string up Trump as their piñata.

So why has California’s vaccine rollout floundered? For one thing, California is the most populous state in the country, with almost 40 million residents, and it is geographically the third-biggest state. It’s culturally, ethnically, and socioeconomically diverse. It’s also currently battling a coronavirus case surge that is sucking up resources from overwhelmed hospitals and public health departments.

Those elements together make vaccine distribution more complicated in California. But according to John Swartzberg, a University of California, Berkeley, infectious disease specialist, another explanation for California’s glitchy vaccine rollout may be the state’s high-minded effort to ensure that all residents have equitable access to the vaccines. “I think the mistake that California made was we didn’t follow that basic philosophy: ‘Keep it simple,’” he said. “We didn’t keep it simple enough.”

For months, a 70-member advisory committee had been collaborating on ways to develop a plan that would allocate COVID-19 vaccines fairly to high-risk groups and underserved communities. Members of the group, the Community Vaccine Advisory Committee, include representatives of dozens of industry organizations and nonprofits from across California. To name just a few: the AARP, the California Association of Area Agencies on Aging, the California Rural Indian Health Board, the California Association of Veteran Service Agencies, California LGBTQ Health and Human Services Network, California Manufacturers & Technology Association, Catholic Charities, United Domestic Workers, and the Latino Coalition for a Healthy California.

Much of the committee’s discussion focused on equity: The pandemic has hit hard not just the elderly, but those in low-income and minority communities, many of whom live in overcrowded housing, work in essential jobs, and have limited access to healthcare or work-from-home options. These groups include agricultural workers, grocery store workers, and meatpackers. The advisory members recommended prioritizing these socioeconomic groups for vaccination, along with racial minority groups, seeing the rollout as an opportunity to address long-existing racial and socioeconomic inequities in the state’s health system.

In an effort to reach those underprivileged groups, state officials had largely allowed California’s 58 counties and three cities to figure out their own logistics on the ground. What happened instead was a messy, convoluted rollout that varied county by county, causing widespread confusion and frustration. Some members of the advisory committee wondered if they’d spent more time debating well-meaning ideas on equity than figuring out the logistics of how to vaccinate as many people as quickly as possible.

California Health and Human Services Secretary Mark Ghaly recently acknowledged that the state’s emphasis on equity, while “thoughtful,” may have “led to some delays in getting vaccines out into our communities.” Beyond that and the unpredictable vaccine supply from the federal government, officials haven’t explained in detail why the rollout has been so slow.

Compare California’s progress to North Dakota’s: The latter state has already administered more than 90 percent of its vaccine doses. Officials there prioritized injecting doses into arms as quickly as possible, allowing greater flexibility on who could be vaccinated and avoiding a maze of bureaucracy by letting smaller, independent pharmacies administer the vaccines.

In an effort to simplify California’s system, Gov. Newsom scrapped the original plans to prioritize racial and economic factors and instead announced on Jan. 25 a new vaccine eligibility tier that prioritizes residents by age: It’s easy to screen a person’s date of birth, but not so easy to verify a person’s risk factors, which could require stacks of medical or employment documents. The state also announced plans to use a third-party administrator, Blue Shield of California, to serve vaccines rather than using local counties and hospitals, and it pilot-launched a statewide vaccine portal for residents to check their eligibility and schedule appointments.

Age-based eligibility may be the simplest, clearest way to distribute vaccines, “but it’s not going to be equitable,” Swartzberg warned. “No matter how you parse it, somebody will be unhappy. Lots of people have very good reasons on why they should get the vaccine first. It’s a no-win situation.”

Already, plenty of people have voiced disappointment. Equity advocates point out that Latino residents are dying at three times the rate of white residents, and that residents in the poorest neighborhoods had the highest rate of COVID-19 deaths. By moving other people further ahead in line, many of the poorest and most marginalized will be pushed further back, they argue.

Alex Tirpack is one of those unhappy about the governor’s new plan. He’s 36 years old and works alone at home in Orange County, so a 55-year-old healthy individual will likely get the vaccine before he does—but Tirpack is at higher risk of dying from the virus. Ten years ago, Tirpack fell off a roof and suffered a spinal cord injury that left him a paraplegic. His injury affects his cardiovascular system and places him at high risk of blood clots. Ever since the pandemic, Tirpack has been staying mostly at home, getting his meals and groceries delivered and relying on the kindness of friends and strangers.

Tirpack had been anticipating he might be able to get his first vaccine dose by February or March because of his high risk. So when Newsom switched gears to base vaccine distribution on age, Tirpack felt neglected: “We’re basically being treated as second-class, and that’s a tough thing to stomach when you’re a human being just like anyone else.”

Like many others, he’s unimpressed with the state’s vaccine rollout plan: “It’s not like the pandemic happened last month, or that we were surprised by the vaccines. We had 10 months to figure this out.”

Although they haven’t made all the details public, state officials insist they’ll still pursue equity within the new age-based tier system. One way they plan to do that is to compensate providers in part by “how well they are able to reach underserved communities,” according to Ghaly. LA County, for example, is opening six more vaccine sites in lower-income minority neighborhoods.

Meanwhile, even if California manages to create an efficient and equitable vaccine distribution system, there simply aren’t enough vaccines available yet—a problem not just in California but in every state. Governors are frustrated about not getting advance notice of vaccine doses shipped from the federal government, which makes it difficult to plan distribution. President Joe Biden recently promised to increase vaccine deliveries to states and make them more predictable. He estimates the United States will have enough doses to fully vaccinate 300 million Americans by the end of summer or early fall, though some experts are less optimistic.

But wonky supply logistics are not foremost on the minds of Americans in the middle of the pandemic. Bao Vo spent days clicking on the Orange County scheduling website over and over and typing in his mother’s username: “That’s my first priority in life right now—to get her vaccinated,” he told me.

Then last Saturday afternoon, Vo messaged me excitedly: “I just made an appointment to vaccinate my mom tomorrow!” He felt a wave of relief—but given the constantly gloomy news about the coronavirus, his worries for his mother aren’t completely lifted. He’s “cautiously optimistic,” he told me: “This is just one step of many.”