Will vaccine end up bypassing hardest hit?
Health providers serving largely minority areas fear equity in vaccinations still will remain elusive
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.”