Huge regional variations in vaccination rates for seniors.
Fewer getting shots in many rural areas
Even as California prepares to expand vaccine eligibility April 15 to all residents age 16 and up, the state has managed to inoculate only about half its senior population — the 65-and-older target group deemed most vulnerable to death and serious illness in the pandemic.
Overall, nearly 56% of California seniors have received the full course of a COVID-19 vaccine, according to the latest data from the federal Centers for Disease Control and Prevention. That’s about average compared with other states. The data does not include seniors who have received only the first dose of the Pfizer-BioNTech or Moderna vaccine.
But California’s overall progress masks huge variations in senior vaccination rates among the state’s 58 counties, which largely are running their own vaccine rollouts with different eligibility rules and outreach protocols. The discrepancies notably break down by geographic region, with the state’s remote rural counties — generally conservative strongholds — in some cases struggling to give away available doses, and the more populous — and generally left-leaning — metropolitan areas often have far more demand than supply.
In Marin and Contra Costa, for example, more than two-thirds of seniors are fully vaccinated. Meanwhile, in the far northern reaches of the state, rural counties like Tehama, Shasta and Del Norte have fully vaccinated only about a third of senior residents, according to the CDC data.
“We have a fairly high percentage of people who are vaccine-hesitant. And that even spreads into the seniors,” Dr. Warren Rehwaldt, health officer for Del Norte County, said of the Northern California counties with relatively low vaccination rates. Del Norte, which is 62% White and voted solidly for Donald Trump in 2020, has vaccinated 36.6% of residents ages 65 and older.
The county, population 28,000, has spotty internet service, leaving the health department reliant on phone appointments for its clinics, which can give out 300 doses inaday.
“I don’t think we have filled any
of them completely, and they are tapering off,” Rehwaldt said. Often, 100 or more appointment slots go unused, even after the county expanded eligibility to age 50 and up.
On the other end of the spectrum are counties like Marin, where 71.4% of seniors are fully vaccinated.
“There’s a thread of privilege that does lead to ease of access to vaccines that needs to be acknowledged,” said county public health officer Dr. Matt Willis. Many Marin seniors have access to computers and cars, he said, and have been able to access vaccine appointments with relative ease.
Still, the county made an aggressive plan to vaccinate seniors, he said. The health department sent in workers into long-term care facilities as soon as it had vaccines, for example.
The county also kept its eligibility rules focused on seniors ages 75 and older through the middle of February, while other counties were expanding to younger age groups and an array of occupations.
“We showed that a dose offered to someone 75 and older in Marin was 320 times more likely to save a life than a dose offered to someone younger than 50,” Willis said.
Contra Costa County has done nearly as well: 70.9% of seniors are fully vaccinated. Add in those who have received at least one dose and the numbers are far higher: 90% of people ages 65-74 and 97% of those 75 and older, according to the county’s vaccine tracker.
To reach vulnerable seniors, Dr. Ori Tzvieli, Contra Costa’s deputy health officer, said the county sent mobile clinics to residential care facilities and lowincome senior housing. “For people who were literally homebound, we send someone inside. Otherwise, we set up a station in the lobby or right outside,” he said.
The county also set up mobile clinics at farms and places of worship. And rather than have residents track down their own appointment slots online, the department had people fill out forms and then scheduled appointments for them, giving priority to those in low-income ZIP codes with high rates of disease.
With a population of just over 1 million, Contra Costa now is able to vaccinate 100,000 people a week, Tzvieli said, and has opened eligibility to everyone over 16. But inequalities remain. In Bay Point, for example, a largely working-class Latino community, vaccination rates are just half of those of some wealthier communities, he said.
In the Central Valley, Fresno County falls somewhere in the middle on vaccination rates. About 54% of seniors 65-plus are fully vaccinated, just under the state average. Just more than half the county’s residents are Latino, many of them farmworkers. About a fifth of the population lives in poverty, which presents its own hurdles.
“Poverty immobilizes, physically and mentally,” said Joe Prado, Fresno County community health division manager. “For a wealthier population, going 3 to 5 miles away is simple; you hop in the car and go. But if you’re living in poverty, that’s a big barrier.”
Prado said most seniors eager for the vaccine have received at least an initial dose: “The final 25% is going to be the most resource-intensive, the most difficult to reach.”
Dr. William Schaffner, an infectious disease specialist at Vanderbilt University, calls this public health’s “low-hanging fruit phenomenon.” As the proportion of people who are vaccinated grows, he said, “We’ll have to work proportionally harder to keep advancing these numbers because the eager beavers go first.” In rural counties from California to Tennessee, he added, supply is already outpacing demand.
Just over 75% of seniors in the U.S. have received at least one dose of vaccine, according to the CDC.
“You can look at that as the glass is half-empty or half-full,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, during his weekly podcast. That still leaves more than 13 million seniors unprotected despite facing the highest risk of death; 8 in 10 deaths from COVID-19 in the U.S. have been among adults 65 and older.