The Mercury News Weekend

State’s strategy: Vaccine equity

Bay Area’s underserve­d areas, most vulnerable communitie­s earmarked for more doses

- By Marisa Kendall mkendall@bayareanew­

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.”

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