Why is the vaccine rollout so slow in Sonoma County?

“Something is wrong with Sonoma County!” Martin Webb, a retired high school principal, said in an email. “Contra Costa County started yesterday (to) give shots to those over 65 in Fairgrounds and did over 2000. Why can they do it but not Sonoma. Someone put us behind the ball on this issue.”

Webb’s plea, sent to a reporter Jan. 16, might have been a little more adamant than most. But his point of view is shared by countless people in Sonoma County.

Why, they wonder, aren’t more of their neighbors being vaccinated against the novel coronavirus, which has infected more than 24,700 county residents since last March, killed 247 of them and done lasting damage to the local economy and to the social fabric of our community? We had weeks, perhaps months, to prepare for this mobilization. What could possibly be bogging it down to this extent, where assisted living centers are waiting in confusion for first doses and 85-year-old cancer survivors have no idea when their turn will arrive?

The answers aren’t very satisfying, because they are predictably tangled and complex. All levels of public governance, from the administration of President Donald Trump to county administrators, bear some share of responsibility. The state of California has made the situation worse by promising vaccine availability it cannot facilitate. But beyond clunky messaging, it can be hard to identify specific, egregious acts of incompetence in the first few weeks of the rollout.

“A lot of public health resources had to be diverted to controlling the pandemic itself,” said Lee Riley, a professor of epidemiology and infectious diseases at UC Berkeley. “Then we suddenly need to distribute this vaccine. Health officials were overwhelmed, and also front-line providers.”

As of Thursday, the last day for which numbers were available, fewer than 26,237 doses of Pfizer-BioNTech and Moderna vaccine had been administered in Sonoma County since the vaccination campaign began Dec. 15, excluding doses taken into nursing homes by the CVS and Walgreens pharmacy chains. Dr. Sundari Mase, the county health officer, said in a meeting with county supervisors Thursday that 5,033 people had received both ends of a two-dose course at that point, the equivalent of about 1% of the county’s population.

In the week between Jan. 14 and Jan. 20, Sonoma County oversaw the delivery of an average of 905 shots per day. At that rate, it would take roughly three years to vaccinate the entire county, and more than two years to achieve herd immunity, which according to most experts occurs when something close to 70% of a population has been vaccinated.

There is widespread consensus that the federal government failed to build an adequate pipeline for vaccine distribution. The Trump administration invested tremendous energy in Operation Warp Speed, the effort to develop an effective vaccine. It was wildly successful, with Pfizer-BioNTech and Moderna receiving FDA approval in December for their competing formulas after nine months of trials. It’s a process that usually takes several years.

But the administration paid much less attention to what would come next — the distribution of vaccine doses to states and, ultimately, to on-the-ground health staff who would be putting shots into arms. In essence, each state was left to its own devices.

The major hurdles have been reported extensively. They include a lack of resources devoted to staffing and site selection, super-cold storage requirements for the Pfizer vaccine and an initial reluctance by some health workers to be immunized, which resulted in vials going unused in the early going.

But those factors are universal. None explains why California has lagged behind most other states in rolling out the vaccine.

Using the most recent data points, California ranked dead last among the 50 states in percentage of allotted doses administered (38.3%, according to Bloomberg) and 44th among the 50 states in doses administered per capita (4,565 per 100,000 residents, according to the CDC).

Riley, a former program manager at the World Health Organization who is currently director of the Global Health Equity Scholars Program, has sympathy.

“California is a big state, like a country,” he said. “It’s like trying to manage the vaccination system of a full nation. I would say we’re doing relatively well considering the complexity of the state. However, we could do better.”

Is Sonoma County doing better? It’s hard to say, because neither local nor state officials have been releasing data on doses distributed to the counties.

That wasn’t the case when the vaccination program began a month ago. In the excitement of the first week, Mase, the county’s health officer, reported that the state would immediately be shipping 4,875 doses of the Pfizer vaccine, the first to hit the pipeline, through her office.

That sort of transparency disappeared two or three weeks ago. Before then, the California Department of Public Health was posting daily updates on the number of vaccine doses allocated to each county in the state. Sometime during the week of Jan. 3, the chart abruptly disappeared.

“We are currently working on a vaccine dashboard to share the most current information available,” a state Public Health representative said when asked for an explanation. “When we have more to report on its rollout, we will let you know.”

The inscrutability was mirrored in Sonoma County. Spokesman Paul Gullixson said Thursday the county had received 5,925 doses that week, but that was the first update in several weeks, despite repeated requests for data. Gullixson said the county hopes to have that information incorporated into its vaccination dashboard soon.

It might not be a matter of secrecy, at least not entirely. Several people familiar with local vaccine distribution noted that the first shipment of vaccine in December came directly to the county. Since then, the majority of doses have gone to hospital partners and, beginning more recently, to Safeway pharmacies. The county has found it complicated to track the movement of those doses. And that’s to say nothing of the vaccine going into local elder care facilities through CVS and Walgreens, a federal program that completely bypasses local health offices.

“The county is not in the loop, and has no authority on that,” said Jason Cunningham, CEO of West County Health Center. “We’re looking at a true structural issue. This is the problem with a fractured national, state and local government health system, as opposed to Denmark, where I spent a year.”

Just as frustrating to many people involved in Sonoma County’s vaccination drive has been California Gov. Gavin Newsom’s role in placing undue pressure on local health officials. In their eyes, the governor is making promises that county health officers have no hope of fulfilling.

The most prominent example came Jan. 13, when Newsom announced during a video press conference that the state would be opening up vaccinations to all Californians 65 years and older. It felt like a turning point to anxious seniors and their family members, many of whom immediately began reaching out to the county to figure out how they might get in line for doses.

But Newsom’s proclamation contained no mechanism for delivering shots. The state made little change to its complicated system of phases and tiers, other than to elevate residents aged 65-74 into the same tier as those aged 75 and older. All of those seniors — in Sonoma County, that demographic likely includes close to 100,000 people — remain in Phase 1B, behind a wide range of health care professionals. Nor did the announcement signal an expansion of the number of doses emanating from Sacramento.

“That same week when we were told to vaccinate everyone over age 65, we got less than 4,000 doses of vaccine,” said Lynda Hopkins, chair of the Sonoma County Board of Supervisors. “You do the math. It doesn’t add up.”

Newsom’s announcement did give counties more flexibility in placing seniors within the priority system. Some chose to give them a higher position, which brought its own problems. In Fresno, media reports described a line of cars stretching 4 miles to reach one vaccination site. In Orange County, more than 10,000 residents signed up in one day for a mass site in a Disneyland parking lot.

Mase did not alter Sonoma County’s tiers. The simple truth is that the county currently doesn’t have nearly enough vaccine to accommodate its 65-and-above population, which could require something close to 200,000 doses to complete the two-course inoculation process.

“I hate pointing fingers at other levels of government. I don’t like throwing each other under the bus,” Hopkins said. “But I have to be honest. The state has completely abdicated its responsibility on vaccinations. Each county has to invent its own wheel.”

“The way the state has set up the system is a failure,” she added.

Of course, that doesn’t mean Sonoma County bears no share of the responsibility for local coverage. While it has been nearly impossible to get accurate figures, most communication from the county has suggested that somewhere between 50-60% of doses received have found their way to arms. That’s significantly ahead of the statewide rate. But it implies some doses are hanging around for two weeks or more before being administered.

Mase said part of the problem is “sort of mixed messaging” on how much vaccine the state is expecting counties to hold for second doses. “That would certainly impact the percentage, if the doses that you’re holding and not giving out are in the denominator,” she said.

Mase added that even when vaccine doses aren’t reaching arms, they may be earmarked for a specific event.

“So there’s a clinic coming up in the next few days, and we’ve allocated 600 or 1,000 or whatever doses specifically for that,” she said. “I think it’s important that we have a very systematic, aligned way of calculating this, and that is exactly what we’re working on doing.”

Another logical culprit for the lag is a lack of people to administer the shots. The county is enlisting dentists and EMTs and retired nurses in the cause. Cunningham believes this is a crucial piece of the program, because so many hands will be needed when the pipeline expands to mass vaccination sites for the 65+ population. (His guess for when that will happen is mid-February.) As of now, though, he insists staffing shortages have had no ill effects on getting vaccinations out.

“No. It’s been zero,” Cunningham said. “That’s because we are very good at vaccinating our own system. Our hospital staff, community health center staff, that’s getting done.”

Why the sluggish pace then? “It’s the doses,” Cunningham said.

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