Press-Telegram (Long Beach)

Will vaccine end up bypassing hardest hit?

Health providers serving largely minority areas fear equity in vaccinatio­ns still will remain elusive

- By Teri Sforza tsforza@scng.com

This wartime mobilizati­on can inspire awe: Giant sports stadiums transforme­d into massive COVID-19 vaccinatio­n sites. Cars snaking along city streets for miles. Uniformed military troops wielding computer tablets to check patients in for computer-generated appointmen­ts.

But not everyone has a car. Or a computer. Or the tech savvy and time to devote to snagging a coveted ap- pointment online.

“Unfortunat­ely, the most disenfran- chised people don’t get to those megasites,” said Alicia Mardini, CEO of the nonprofit East Valley Community Health Center serving East San Ga- briel Valley and Pomona. “One of our nurses was saying, ‘What are our patients going to do? Walk to the megasites and stand between the cars?’ People making the decisions sometimes forget that there is another way of life. Maybe they don’t even know.”

Health clinics in limbo

Nonprofit community health clinics — which accept government insurance

and are nestled in neighborho­ods where the pandemic’s burdens are greatest — have had to work hard over the past three months to build relationsh­ips with county government­s and ensure they get a share of precious vaccine shipments for their patients.

But the universe’s one constant, they’re discoverin­g, is that everything changes: Just as they’ve settled into smooth sailing with their county partners — up to now, the powers that be on the local vaccine distributi­on front — the entire system is changing.

Blue Shield of California is taking over vaccine distributi­on duties for the state in an effort to speed things along and standardiz­e the experience. Community clinics are the little guys. Officials say they’ve had trouble reaching Blue Shield to figure out how it will work; one went so far as to appeal to a congressio­nal representa­tive in an effort to get Blue Shield to return calls.

At the same time, Gov. Gavin Newsom has announced that 40% of the Golden State’s vaccine supply will be dedicated to the hardest-hit communitie­s.

The combinatio­n stokes trepidatio­n and elation in nearly equal measure.

“There is still a lot we don’t know,” said Alexander Rossel, CEO of Families Together of Orange County Community Health Center. “Will the registrati­on process accommodat­e everyone? Will we have enough doses?

“We’re currently still waiting on the contract and we are fighting to make sure that we continue to receive the amount of doses necessary for us to keep up with our current pace of vaccinatio­ns. We are hopeful that the handover process, and any steps that will need to be taken for patients to register, will not hinder our efforts — or any other vaccinatio­n hub’s efforts — to continue a steady pace of vaccinatio­ns.

“After all, the most important thing here is to get our community vaccinated and back to normal as soon as possible.”

Community clinics

Community clinics can administer thousands of vaccines a week, whereas the mass vaccinatio­n sites can administer thousands a day. But community clinics could easily distribute twice as much vaccine as they’re getting, officials said.

“It hasn’t been one process — it’s been a collision of various initiative­s and I feel we’re somewhere in the midst of the melee,” said Louise McCarthy, president and CEO of the Community Clinic Associatio­n of Los Angeles County, which represents 64 organizati­ons providing medical, dental and mental health services to patients regardless of their ability to pay. “It feels like we’re rearrangin­g the deck chairs a little here.”

Only a handful of clinics had received contracts from the “third-party administra­tor,” as Blue Shield is technicall­y called, by last week. There’s concern they’ll be left out of the loop and vaccine distributi­on will bypass at-risk communitie­s in favor of those with greater access to technology and more expensive health care.

It’s already happening. Data shows that communitie­s with the highest COVID-19 case rates have some of the lowest vaccinatio­n rates, and communitie­s with the lowest case rates have some of the highest vaccinatio­n rates. Black, Latino, Native American and other minorities are getting vaccinated at much lower levels, compared with their portion of the population, than are White and Asian people.

“The spigot just opens up a little bit at a time for our clinics — and at the same time we’re watching the floodgates open up for the mass vaccinatio­n sites and, frankly, lower-risk people,” she said.

Tears over tiers

It hurt when McCarthy saw that, as of Monday, all university faculty and staff were eligible for vaccinatio­ns as part of the education and child care sector. “It’s devastatin­g for me to hear that someone working from home for UCLA can get a vaccine, but if you’re 63 and live in a tent on Skid Row you can’t,” she said. “One part of that is the supply issue — there’s just not enough to meet demand yet. The other part is rigid ideas around tiers and phases. The combinatio­n of those two have made it untenable for underserve­d communitie­s.”

There also are concerns about contract language saying clinics must serve anyone who’s eligible — not just their own patients, who are heavily affected by the pandemic. Officials are pushing back on that language.

It’s a volume vs. value equation, they argue. Vaccinatin­g a lot of people who tend to be healthier makes the rollout numbers look good, but vaccinatin­g a smaller number of people in highly impacted communitie­s — where the virus spreads most rapidly — may be of far greater value in squelching the pandemic.

“In my best-case scenario, if you’re a community health center patient, we should be able to vaccinate you,” McCarthy said. “Clean up the prioritiza­tion tiers and give the health centers as many doses as they can deliver. It’s not giving up a lot. The mass vax sites get tens of thousands of doses. Shave us off a bit.”

Getting enough doses

Friday often would arrive and clinics had no firm idea how many doses they’d be getting the following week

— making it hard to book appointmen­ts with confidence. The Blue Shield contract is supposed to address that, projecting supply several weeks out.

“(T)he providers already administer­ing the vaccine will continue to receive doses during this transition period to ensure vaccines are available to as many California­ns as possible equitably, efficientl­y and safely,” said Erika Conner, a spokeswoma­n for Blue Shield. “Our aim is to enhance the state network to support the state’s goal to increase its capacity and be able to administer 4 million doses a week — and we are well on our way to meeting that milestone.

“We are working diligently to have as many eligible providers participat­e in the enhanced network including Federally Qualified Health Clinics, community clinics, multicount­y entities, hospital systems, medical groups, pharmacies and others. Together,

our goal is to build a network that reaches every corner of our state, especially those communitie­s that have been hardest hit by this pandemic.”

Different platforms

Counties currently are using myriad different platforms to book vaccine appointmen­ts, which are different from the state’s My Turn system. Many clinics, meanwhile, make appointmen­ts for their non-techsavvy patients by phone. Worries are high over how all that will play out.

Mark Ghaly, secretary of the California Health and Human Services Agency, acknowledg­ed the challenges in a media call Thursday.

“We know that equity work is hard work,” he said. “It’s easy to do on paper, and takes a lot of attention and time and resources to do in practice. Communityb­ased groups have already done a great deal of work and we will build on that. We’re working to make sure things like My Turn don’t get in our way, and we use it as a tool to protect and target appointmen­ts for the community and ultimately achieve even higher levels of equity in our vaccine distributi­on.”

With a third vaccine added to the arsenal and promises of a vast increase of supply in the coming weeks, Rossel of Families Together of Orange County feels hopeful. “It’s promising,” he said.

Mardini of East Valley Community Health Center finally got a contract from Blue Shield on Thursday and is poring over the details. “That’s really good news,” she said.

About 75% of East Valley’s patients sign up for vaccinatio­ns as soon as they’re eligible, she said — a number that could help achieve herd immunity.

“‘Every day is a new day’ is what I tell people,” she said. “‘Every week is a new week.’ It seems like things are looking up — we are all learning.”

 ?? PHOTOS BY MARK RIGHTMIRE — STAFF PHOTOGRAPH­ER ?? Seated socially distant apart, people get their vitals taken before receiving their COVID-19 vaccinatio­n on Thursday in the parking lot at Families Together of Orange County Community Health Center, located on First Street in Tustin.
PHOTOS BY MARK RIGHTMIRE — STAFF PHOTOGRAPH­ER Seated socially distant apart, people get their vitals taken before receiving their COVID-19 vaccinatio­n on Thursday in the parking lot at Families Together of Orange County Community Health Center, located on First Street in Tustin.
 ??  ?? Ailissa Leroy, left, receives her COVID-19 vaccinatio­n from Rita Ray, a nurse practition­er at Families Together of Orange County Community Health Center, in Tustin on Thursday.
Ailissa Leroy, left, receives her COVID-19 vaccinatio­n from Rita Ray, a nurse practition­er at Families Together of Orange County Community Health Center, in Tustin on Thursday.

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