State’s strategy: Vaccine equity
Bay Area’s underserved areas, most vulnerable communities earmarked for more doses
A new COVID-19 vaccine strategy could help immunize more vulnerable Bay Area communities that for weeks have been left behind. But with doses still in short supply, the state’s plan to address inequities in distribution hinges on California’s ability to get more shots.
The day after state Health and Human Services Secretary Dr. Mark Ghaly announced that 40% of California’s vaccines will be earmarked for low-income, disadvantaged communities, experts and local officials were cautiously optimistic the plan will help get vaccines to neighborhoods with high numbers of infections and deaths and disproportionately low numbers of immunizations. Once California has administered 2 million vaccinations in those communities — which Ghaly expects to happen in the next week or two — the state will make it easier for some counties to reopen.
“It’s very heartening to see,” said Contra Costa County Supervisor John Gioia, who has been pushing for improved vaccine access in Richmond, San Pablo, Antioch and other underserved areas. “It’s seeing the state following through with its commitment to close the vaccine equity gap. I think it’s absolutely necessary.”
But as California expands vaccine access, it’s stretching a limited supply of doses increasingly thin. In addition to the shots reserved for underserved communities, Gov. Gavin Newsom has set aside 10% of the state’s supply for teachers. And on March 15, California will expand
vaccine eligibility to people with medical conditions, including cancer, chronic kidney and pulmonary disease, heart disease, severe obesity and Type 2 diabetes.
Ghaly said no California communities should see their vaccine allocation reduced due to the new strategy — and some will see their allotments increase.
However, Newsom acknowledged supplies are tight. Last week, the state administered 1.7 million vaccinations. But next week, he expects to receive 1.62 million doses. He and Ghaly are counting on the supply increasing in coming months as the new, one-dose Johnson & Johnson vaccine ramps up.
The plan unveiled late Wednesday prioritizes communities based on a metric known as the California Healthy Places Index, which grades census tracts based on income, education levels, access to transportation, health services and other factors. Neighborhoods in the bottom quartile of that index — which includes much of East San Jose, East and West Oakland, San Francisco’s Bayview and Tenderloin districts, and parts of Richmond, Gilroy, Antioch and Pittsburg — will be prioritized for vaccination. Census tracts that are part of the new strategy are spread across about 400 ZIP codes and also include wide swaths of the Central Valley and less-wealthy areas in Southern California.
Between 16% and 17% of the state’s vaccines have been administered in neighborhoods ranking in the bottom quartile of the Healthy Places Index, Ghaly said Thursday. By comparison, 34% have gone to communities ranking in the top quartile. But it is the underrepresented communities, largely made up of low-income residents of color, that have been hardest hit by the virus. Latinos have borne 55% of the state’s COVID-19 infections, despite making up just 39% of the population.
“We’re still falling short,” Newsom said of efforts to distribute vaccines equitably. “We’re not meeting our goals.”
Dr. Fola May, a physician and health equity researcher at UCLA, said she’s “thrilled” the state will start targeting underserved populations.
“Achieving equity with vaccine distribution assures that we all will defeat this pandemic,” she said. “And we need to recognize that we’re only going to do as well as we do in the populations that have the least access and the highest burden of disease.”
But many people living in the areas targeted by Newsom’s new strategy may not trust the vaccine or may have been exposed to misinformation about its safety and efficacy, May said.
To address that, the state has invested $52.7 million in 337 community organizations to help them send representatives into their neighborhoods to build trust in the vaccine, Newsom said. The state intends to partner with trusted local community clinics and health care providers to distribute the vaccines.
Another issue is how officials will ensure shots go only to the residents they’re earmarked for. The state provides codes to allow eligible people access to appointments, but there have been reports around the state of people misusing those codes.
Newsom said Thursday the state now generates codes for individuals rather than for groups, to make them harder to abuse, but it’s unclear if that will be enough.
It’s a tough issue to address, May said. On one hand, clinicians need to make sure interlopers aren’t cutting the line. On the other hand, forcing patients to prove residency could discourage or prevent people, including undocumented immigrants, from getting a shot.
“We are working on this,” Newsom said. “It’s whack-amole every single day.”
Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network, applauded Newsom’s new strategy.
“These are the communities where we have seen the greatest community transmission of COVID-19 and the greatest share of severe illness, as well as death,” she said. “So we really need to focus our efforts on controlling the pandemic in the areas where we see the greatest spread.”
Though Contra Costa County’s Gioia was excited by the news, he’s awaiting more details. In Walnut Creek, an affluent, largely White city, nearly 41% of residents have received at least one dose of the vaccine. In Richmond, a lower-income city with a large Latinx population, nearly 16% of residents have received at least one shot.
“There has been progress,” he said, citing recent mobile vaccine drives targeting lowincome areas. “There’s still a vaccine equity gap, and I think that’s still problematic. But the county has definitely ramped up its equity efforts.”