California’s equity drive may slow Sonoma County vaccinations

New state guidelines unveiled Thursday that set aside 40% of coronavirus vaccines for the poorest Californians threaten to further inhibit shipments of doses to Sonoma County, where deliveries of the precious vaccine have remained stagnant in recent weeks.

Sonoma County leaders, who have labored to build a network of clinics capable of vaccinating 40,000 people a week, now expect to receive fewer than 8,000 doses next week for the third straight week.

“For a while, doses were ramping up and it felt good,” Lynda Hopkins, chair of the county Board of Supervisors, said Thursday. “Suddenly we have the capacity to vaccinate 40,000 per week, and we’re basically at the same place we were a month ago with the doses.”

The state’s plan, as outlined by Health and Human Services director Dr. Mark Ghaly, reserves 40% of California’s vaccine supply for ZIP codes in the lowest quartile of the state’s Healthy Places Index (HPI). That index relies heavily on income data, but also includes factors such as housing, transportation and access to health care.

The lowest quartile represents roughly 400 ZIP codes, Ghaly said. None are in Sonoma County, according to an interactive HPI map created by the Public Health Alliance of Southern California.

The precise impact of the new directive on the local vaccination campaign is unknown at this time. But the implication is worrisome for a county whose allocation of doses has been almost flat for several weeks.

Two weeks ago, Sonoma County got 8,025 doses from the state (a figure that includes vials shipped directly to medical providers). Last week it received 7,610. The county got 7,680 this week, and is scheduled to receive 7,700 doses next week.

“It’s like a flow of water that never seems to trickle down to Sonoma County,” Hopkins said.

That trend has locked the valve on a vaccine pipeline that had been steadily growing since the national program rolled out in mid-December. This is the first week Sonoma County has received its allotment plan for the following week directly from Blue Shield, now in charge of coordinating California’s vaccination effort.

“We really don’t have any information, whether it’s related to the rollout at all,” Dr. Urmila Shende, the county’s vaccine chief, said of the low number of doses coming. “I think it has more to do with just limited supply and the wait for the supply and manufacture to increase.”

Vaccine shortages linger

The ongoing shortages forced the county to forego first doses at all of its affiliated vaccination clinics this week, and spurred Sutter Health to cancel even second-dose appointments at sites throughout its network. A Sutter spokeswoman said Thursday that the provider is being allocated 30,000 doses next week and 30,000 for the week of March 15 across Northern California — just two-thirds of what it needs to complete second-dose courses for approximately 90,000 seniors and health care workers.

“We are hopeful the state will provide the additional 30,000 so we can bring back all of our patients for their second dose of the vaccine within the CDC’s recommended time frame,” she said.

This atmosphere of scarcity is incongruous with President Joe Biden’s pledge this week of vaccinating every adult American by the end of May, and with the introduction of a third vaccine formula to the national supply chain, a one-dose version developed by Johnson & Johnson. Sonoma County is set to receive 1,700 doses of Johnson & Johnson next week, yet its total allotment remains almost unchanged.

“We were under the impression Johnson & Johnson would be on top of a stable allocation of Pfizer and Moderna,” Hopkins said. “That was not the case. Staff was in kind of a panic when we found out, trying to make sure we have adequate supply for second doses.”

Sonoma County has not yet had to cancel any second doses this week or next at the clinics it coordinates with independent site managers, said Ken Tasseff, the county’s vaccine site coordinator.

The state’s decision to set aside doses for underserved neighborhoods makes sense. Those areas have suffered disproportionately during the pandemic, especially in communities of color. Residents of those neighborhoods have been infected by the coronavirus at a higher rate, and tend to have more existing health conditions that could make them vulnerable to COVID-19. They are more likely to live in overcrowded or congregate spaces, and less likely to have been able to work from home over the past year.

And they have found it harder to get vaccinated. Ghaly said lowest-quartile HPI communities have been receiving 16% to 17% of the state’s vaccine supply to date, as opposed to 34% for the highest quartile. For those reasons, the new equity goal was greeted warmly by a wide range of health and social justice advocates.

“Latinos represent only 17% of those receiving the vaccine to date, far below (their) 39% share of the state’s population. It is clear that more needed to be done,” Dr. Jeffrey Reynoso, executive director of the Latino Coalition for a Healthy California, said in a statement. Reynoso added that bumping up allotments to affected communities “will not only protect Latinx households, but safely accelerate California’s economic reopening.”

Vaccine distribution in the county

Darker color indicates higher vaccination level. Click on each zip code for vaccination rates.

Disparities in Sonoma County

That disparity also exists in Sonoma County, when Hispanics/Latinos make up 27.3% of the population but have received just 18% of the vaccinations.

The ZIP codes falling into the lowest quartile are not distributed evenly across the state, however. There are large concentrations in the San Joaquin Valley, and in urban neighborhoods in Los Angeles, Riverside and San Bernardino counties. There are also low-quartile tracts in Lake and upper Mendocino counties. But none are in Sonoma County.

That doesn’t mean there aren’t low-income residents and underprivileged communities here.

“It’s heartbreaking,” said Pedro Toledo, chief administrative officer at Petaluma Health Centers, an organization that sends its fieldworkers into isolated communities in an effort to enroll people in health coverage. “I’d go and look at a ranch, go into the barn, and there would be bunk beds. You could see children are living there. Multiple families are living there. Those are the individuals most at risk.”

The Hispanic/Latino community, at 27.3% of the population, has accounted for 65% of the coronavirus infections and 39.5% of COVID hospitalizations in Sonoma County.

“In terms of public health, the strategy has always been to identify who’s being infected, and to contain it,” Toledo said. “Because if you can stop infection from spreading, you’re protecting the rest of the community. When we address tuberculosis, that’s how we handle it. Same with other infectious diseases. That should be the goal with the COVID pandemic, too.”

The state’s hyperlocal equity focus looks familiar to Toledo. Petaluma Health Centers has been targeting underserved ZIP codes in Sonoma County for weeks, zeroing in primarily on neighborhoods in Roseland and Rohnert Park.

Reserving 40% of the state’s vaccine supply for eligible Californians in specific ZIP codes, and another 10% for education and child care workers, would seem to leave a smaller batch of doses for everyone who doesn’t fit into those categories. And the search for shots promises to become more intense March 15, when the state’s vaccine eligibility tiers will open to people with existing health conditions and disabilities — a group representing 4 to 6 million Californians.

Ghaly insisted the new equity standard will have no bearing on that March 15 eligibility.

You can reach Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post.