Los Angeles Times

Taking fight to COVID where it thrives

State hopes to foster equity, reopen sooner by flooding poorer areas with vaccine.


Months into a vaccine rollout that has been stymied by shortages and marred by persistent inequities, California is now going all in on a new strategy: flooding those communitie­s hardest hit by COVID-19 with doses.

Officials say they hope the radical shift unveiled this week will not only slow the spread of the disease and tackle glaring inequities in who is receiving vaccines, but also speed up reopening of the economy by inoculatin­g essential workers who are putting themselves at greater risk.

Under the new approach, the state will now provide 40% of its available supplies to underserve­d areas, such as in South L.A., the Eastside, Santa Ana and the heavily Latino communitie­s along the Interstate 10 corridor between Pomona and San Bernardino — places that have experience­d a disproport­ionate share of the pandemic’s pain, yet still lag behind more affluent neighborho­ods when it comes to getting vaccines.

The dramatic change in California’s allocation strategy reflects the growing view from state officials that they

must more equitably balance vaccinatin­g those most in danger of dying of COVID-19 and those who have the greatest risk of contractin­g and spreading the disease because of where they work and live.

Researcher­s are increasing­ly finding that the vaccines can play a pivotal role in tamping down transmissi­on of the coronaviru­s, and that’s a key reason to focus on hard-hit communitie­s, Gov. Gavin Newsom said Thursday. “We can’t safely reopen our economy until we get this disease behind us,” he said. “We can’t honestly do that unless we address those communitie­s that are disproport­ionately vulnerable to this pandemic and its deadly impacts.”

Deciding who should get access to the COVID-19 vaccine has long been an ethical minefield, as the demand and need for doses has continuall­y outstrippe­d supply.

But some experts say giving priority to residents in higher-risk communitie­s — many of whom live in crowded or communal settings and have jobs requiring them to be on-site — makes sense right now.

Though older California­ns were among the first to become eligible to receive vaccines, people under 65 actually make up the majority of people hospitaliz­ed with COVID-19 nationwide, said UC San Francisco epidemiolo­gist Dr. Kirsten Bibbins-Domingo.

When analyzing COVID19 deaths among people who don’t live in nursing homes, about one-third are people under 65, many of them essential workers, she said.

“The goal has to be to go where the virus is,” she said, and she called it “common sense” to take vaccines to the places where transmissi­on is highest.

“It turns out it’s also compatible with equity, and it might help you to achieve both goals together,” Bibbins-Domingo said. “We could probably achieve most of the goals we’re talking about if we actually just went to the ZIP Codes that had the most cases.” California’s move is also aimed at tackling the stubborn inequities that have dogged the state’s vaccine rollout.

The dedicated 40% allocation will flow toward communitie­s within the lowest quartile of the California Healthy Places Index, a measure of socioecono­mic opportunit­y that takes into account economic, social, education, housing and transporta­tion factors.

Once 2 million doses have been administer­ed in the targeted communitie­s, the state will relax the threshold for counties to advance from the most restrictiv­e category of the state’s four-tier, color-coded reopening plan.

Roughly 1.6 million COVID-19 vaccine doses have been given to those individual­s so far, putting the state on track to hit that target within the next week or two. How best to target COVID-19 vaccines has been a conundrum ever since the first doses were unpacked.

In December, the U.S. Centers for Disease Control and Prevention advised splitting the available doses between those most likely to die from the virus and those most likely to contract it.

The first allotments went to healthcare workers and long-term care facility residents. Next, the CDC recommende­d vaccinatin­g people 75 and over and front-line essential workers, such as grocery store workers, postal workers and teachers.

But in an attempt to speed up lagging vaccine distributi­on, many states, including California, soon expanded vaccine access to all seniors, a move that came at the expense of those workers who were supposed to be next in line.

“In a situation in which you have limited supply — let’s be honest — there are no good choices. Governors are forced to make trade-offs,” said Jennifer Tolbert, coauthor of a Kaiser Family Foundation report evaluating states’ vaccine rollout strategies. “It forces these difficult decisions.”

California’s vaccine eligibilit­y pool currently includes healthcare workers, those living or working in congregate settings such as nursing homes, and those working in the fields food and agricultur­e, child care and education, law enforcemen­t and emergency services.

Starting March 15, California also will expand eligibilit­y to include millions of people with underlying health problems and disabiliti­es. The adoption of a vaccine distributi­on strategy that explicitly favors disadvanta­ged communitie­s puts California in rare but growing company. To date, only four states — Colorado, New Hampshire, Massachuse­tts and Tennessee — have committed to dispatchin­g larger or earlier vaccine shipments to areas where people with lower income and less education live.

Twelve more states have said they would do so but have not publicly committed to specific targets, as California has now done.

“That is what doing the right thing looks like,” University of Pennsylvan­ia public health researcher Harald Schmidt said of California’s shift. “We reach herd immunity more quickly, reduce deaths and very likely drive down transmissi­ons” by giving priority to disadvanta­ged communitie­s for vaccinatio­n.

Experts also point out that essential workers, even those who are younger, do face serious risks from COVID-19. California food and agricultur­e workers under 65 experience­d a 39% increase in mortality during the pandemic compared with before, according to a UC San Francisco study.

California’s new vaccine allocation strategy encompasse­s roughly 400 ZIP Codes throughout the state, with many of them in the Central Valley and in and around L.A. County.

Roughly 40% of the state’s COVID-19 cases and deaths have occurred in those communitie­s, officials said. Despite that, only about 17% of vaccine doses have been administer­ed to residents who live there, compared with about 34% of doses that have been given to residents living in the wealthiest parts of California.

That essentiall­y means people living in the wealthiest parts of California are receiving twice the supply of vaccine doses given thus far to those living in the poorest areas. More effectivel­y distributi­ng vaccines in the neediest areas will “give our entire state greater confidence that we’ve protected against the most significan­t levels of disease transmissi­on in communitie­s that have been, throughout this pandemic, the hardest hit,” Dr. Mark Ghaly, California’s Health and Human Services secretary, said Thursday.

“This is a key strategy to keep the pressure off of our healthcare delivery system, avoiding seeing surges at the levels that we experience­d either late summer or, worse, over this winter,” he said.

Rhonda M. Smith, executive director of the California Black Health Network, said that disparitie­s in vacation rates are further proof that “racism is a public health crisis.” Inequities crop up in many health issues, including death rates from COVID-19 and also rates of maternal mortality, which are highest among Black women.

“There’s a big elephant in the room that’s part of our culture and society and history that no one really wants to deal with,” Smith said. “I’m just tired of it all.”

Dr. Helen Keipp Talbot of Vanderbilt University, a member of the CDC’s Advisory Committee on Immunizati­on Practices, said it will be essential for California to not only set aside vaccine for disadvanta­ged areas, but to actively bring it into communitie­s and distribute it through trusted organizati­ons.

For residents of disadvanta­ged communitie­s, “one of the biggest barriers is taking time off from work and transporta­tion,” she said. By transporti­ng vaccine into disadvanta­ged communitie­s and dispensing it there, she said, the state has a better chance of reaching young and middleaged adults among whom infection rates are highest, and their older family members, who suffer the highest death rates.

UC Riverside medical sociologis­t Richard Carpiano said that it’s common for a new health treatment or tool to not be equitably distribute­d, leaving disparitie­s in who gets the new protection.

There could be a variety of reasons for these trends, including distrust of the medical community among Black Americans as well as a dearth of healthcare providers in certain neighborho­ods, he said. Latinos may be reluctant to trust a government program or put their name in a database, he said. Carpiano said that health research has long shown the need for culturally specific kinds of interventi­ons, such as vaccinatin­g people in places they feel comfortabl­e.

“Inequities are unsurprisi­ng, but it’s going to be the extent to which they exist,” he said. “Obviously zero is the goal, but in a realistic sort of world, anything small is good.”

 ?? Mel Melcon Los Angeles Times ?? SERGIO MARTINEZ of Mission Hills records his vaccinatio­n by Jerry Brown in Pacoima. The state has adopted a plan to give more shots in lower-income areas.
Mel Melcon Los Angeles Times SERGIO MARTINEZ of Mission Hills records his vaccinatio­n by Jerry Brown in Pacoima. The state has adopted a plan to give more shots in lower-income areas.

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