With demand for the coronavirus vaccine vastly outpacing supply, California’s efforts to methodically plan who gets a vaccine and when are quickly being thrown out the window.
At Lompoc Valley Medical Center, officials had planned to give out 100 doses to people 75 and older on Wednesday, its first day of vaccinations. But word-of-mouth quickly traveled through the small city in Santa Barbara County and by day’s end 350 people had received a shot, many without the required appointment, hospital chief executive Steve Popkin said.
“Understandably, there was a lot of excitement among these members of our community,” he said in an email.
Chuck Ruffner, 74 and with an underlying health condition, was among those inoculated. He got a call Wednesday morning from a friend, who learned through their mutual medical group that shots were available. Ruffner arrived, got vaccinated in 20 minutes and called two friends who came to the hospital to get their shots.
None had appointments. Ruffner didn’t even know what brand of vaccine he received until he checked the next morning.
“It didn’t matter,” he said. “I was just so anxious to get it.”
It’s just one example of vaccine providers not adhering to their own schedules or the rules created by the state, which itself angered many local health officials by quickly adding those over 65 to the priority list this week, despite severe vaccine shortages. More than 10 million people are now eligible for vaccines but only about 900,000 have gotten shots.
Sometimes those providing vaccinations encounter unforeseen problems, like a broken freezer at a Northern California hospital that set off a scramble to quickly use 850 doses. A Southern California hospital vaccinated local first responders after too few health care workers wanted available doses.
Elsewhere, counties are offering vaccines to different groups of people and turning to a variety of methods to notify them when it’s their turn. In Fresno County, for example, anyone over 75 can make an appointment on the county website’s homepage for a vaccination at the local fairgrounds. Yolo County has a Google form people can fill out. San Francisco, meanwhile, hasn’t adopted a central approach to inform the general public.
“The county should serve as a one-stop-shop to ensure everyone has the information and access to the vaccine, and the county is still not providing that function,” San Francisco Supervisor Matt Haney said. “Most of our residents, even ones that should be a priority, are totally in the dark.”
A Tuesday directive by the federal government to vaccinate people over 65 complicated things further; California’s state public health department was still in the stage of suggesting only health care workers and those in nursing homes and similar facilities be vaccinated, even as many counties were moving beyond that.
The problems aren’t unique to California. In Nashville, the city’s public health department announced that people can throw their name in a lottery that would give them a chance to snag any vaccine doses that may be leftover at the end of the day. On the first day the lottery was offered, the city received 15,000 entries and two people were eventually selected to be given a leftover vaccine dose. In Washington, D.C., a grocery store pharmacist vaccinated a law student and his friend who happened to be around rather than throw away the extra doses. In Florida, hours-long lines formed when the state offered vaccines to those over 65 on a first-come, first-served basis.
“There really isn’t a modern example” of vaccinating at this scale, making best practices hard to define, said Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security.
She said it’s essential that vaccinators have flexibility in administering doses, so long as they are open with the public about their decisions. That’s particularly true in cases where vaccines are at risk of going to waste.
Once a first dose is drawn from a Pfizer or Moderna vial, all doses must be given within six hours. Counties could publish their guidelines for what happens when extra doses are available or distribute guiding principles so the public trusts that vaccines aren’t being given out improperly, she said.
“Everybody is afraid of being the health care institution that’s in the headlines for giving to the ‘wrong’ people, and I really think that that fear is stifling some of the progress,” she said. “My suggestion is that we don’t discourage flexibility but we encourage transparency around the process.”
California state officials have acknowledged much of what happens is out of their hands, saying they want counties to follow state guidelines but for the most part won’t punish them when they don’t. The state has not laid out any specifics on what a county should do with extra vaccines.
“We just want to say that we should not waste vaccine,” California Health and Human Services Secretary Mark Ghaly said Tuesday, acknowledging that distributors are making decisions on the fly. “We know that our providers and those who are in charge of vaccinating are very thoughtful, innovative people.”
Sacramento and Yolo Counties are among those trying to anticipate problems before they happen. Sacramento County has a waitlist that officials can turn to if there are extra doses available.
Jenny Tan, a spokeswoman for Yolo County that is home to about 220,000 people, said creating a form that anyone can fill out to be notified when they are eligible is a way to provide the general public with some sense of security that they are in line.
“They need something tangible to kind of latch on to,” she said.
The county has only dealt with extra vaccine doses on a small scale, such as having three or four extra doses at a time. If that happens, vaccinators try to turn to people on-site who may want the dose. In a few cases with no immediate takers, the extra doses were offered to emergency services staff or public health workers.
“We try to time out and number our doses pretty well so it doesn’t get to that point,” Tan said.