County wary of vaccine accord
Marin has yet to cede control to Blue Shield
Marin County is one of a number of counties in California that have not yet signed a contract to allow Blue Shield to manage allocation of COVID-19 vaccines in their jurisdictions as mandated by Gov. Gavin Newsom.
“We had our first conversations with Blue Shield yesterday,” Dr. Matt Willis, Marin’s public health officer, said on Tuesday. “We certainly haven’t signed anything yet. The fact is most counties across the state have not yet signed contracts with Blue Shield.”
On March 8, Santa Clara County Executive Jeff Smith proclaimed his county would not sign a contract to hand over control of vaccine distribution to Blue Shield. A group of counties, including Los Angeles, have rebelled against the Blue Shield plan.
“We know where the populations are, we know who the players are, we know who the vaccinators are, and they’re going to ask a private corporation to give them advice?” Smith said on Wednesday. “It’s absurd.”
During a Marin Healthcare District meeting on Tuesday, David Klein, CEO of MarinHealth, said, “I don’t see any advantage or any opportunity for improvement with Blue Shield. We’re do
ing really well, and I think most counties are. I don't think most hospitals in the city of San Francisco really want Blue Shield to interject another intermediary.”
Jennifer Rienks, who heads the Marin Healthcare District board, said, “It's fixing something that is not broke.”
Willis said, “One of the negotiation points before we sign is we really want to see better assurances that the My Turn registration platform has the ability for us to protect appointment slots for vulnerable groups.
“Right now it is a very blunt tool that really just allows appointments to be accessed by anyone both within and without the county,” he said. “We see it as an important equity process for us to be able to make sure that our underserved communities have access.”
Willis said the one time Marin County used the My Turn website to register
people for shots at its mass vaccination site at the Marin Center, more than half of the people who showed up were from outside the county.
The controversy comes as the March 17 deadline to submit signatures for the petition to recall Newsom draws near. Organizers say they have collected more than enough signatures to get the measure on the ballot.
Delivering his State of the State address from Dodger Stadium on March 9, Newsom asserted that California has the “most robust vaccination program in America.”
“Think about this,” Newsom said. “California now ranks sixth in the world for vaccine distribution, ahead of countries, not states, ahead of countries like Israel, Russia, Germany and France.”
But a rating by Becker's Hospital Review released Friday ranked California in 42nd place among 50 states and the District of Columbia, based on the percentage of COVID-19 vaccines they've administered of those that have been distributed to them.
Asked during a press conference Friday whether the state might cut off vaccines to counties that refuse to work with Blue Shield, California Health and Human Services Agency Secretary Dr. Mark Ghaly said, “I'm going to defer that question. I will tell you the third-party administrator is the state, we give our direction to Blue Shield. They are working on our behalf.”
On Wednesday, Santa Clara County announced it had stopped scheduling first-dose COVID-19 vaccine appointments due to a lack of supply.
In a separate news conference Friday, Paul Markovich, president and CEO of Blue Shield of California, said the Santa Clara shortage happened because “the state did not have up-todate, accurate inventory
numbers by individual providers and hasn't up to this point.”
“As a result, some of the big providers like the University of California and Sutter started to run out of vaccines and were not getting allocated doses by the state at the level that they needed to fulfill second dose appointments,” Markovich said.
He said when Blue Cross redirected more doses to those two entities, it caused the Santa Clara shortage.
Markovich said state officials are in discussions with counties about signing a memorandum of understanding with the state in lieu of a contract with Blue Shield.
“Which is fine by us,” Markovich said. “As long as there is agreement that they will participate in the performance management system that allows us to deliver on the performance in our contract.”
Markovich said how much vaccine each county is allocated will depend on two factors: the state's preferences regarding geographic distribution of the vaccines, and how effective
counties are in using the vaccines equitably.
On Tuesday, Willis told Marin supervisors that he had written to the state officials to object to their decision to allocate 40% of vaccine supplies to residents who live in ZIP codes that have been hit the hardest by COVID-19.
Willis said the policy ignores the needs of Latino residents in San Rafael's Canal neighborhood, which has suffered greatly during the pandemic.
But William Padula, a professor of pharmaceutical and health economics at the University of Southern California, thinks Blue Shield, with longstanding relationships across the state, has the ability to speed up the vaccine distribution process and worries that back-and-forth dialogue between the counties and state is only going to slow things down and hurt Californians.
“At this point,” Padula said, “sending the state back to the drawing board to rethink this public-private partnership, right now all it's doing is setting us back further.”