San Francisco Chronicle | Catherine Ho, Meghan Bobrowsky
Greg Garrett was overjoyed when he heard that California was abandoning its vaccine eligibility restrictions and opening shots to everyone 16 and older on April 15.
“Hallelujah!” said Garrett, chief operating officer of the Native American Health Center, where staff have been working furiously to set up vaccination sites at churches, in affordable housing common rooms and community center parking lots in East Oakland.
The neighborhood has one of the highest infection rates in Alameda County, and community clinics like Garrett’s are critical to bringing shots to residents who would otherwise have a hard time getting them from mainstream health care providers or large mass-vaccination sites. Garrett hopes that opening eligibility — along with the anticipated increase in vaccine supply — will mean his center can inoculate more people, faster, in neighborhoods that need it the most.
“In Alameda County, 75% of 65-year-olds are vaccinated,” Garrett said. “Where’s that other 25%? We’re reaching them. We’re getting into the crevices and cracks within the social system.”
That’s the kind of targeted, hyper-local work that must expand in order to ensure equitable vaccine distribution as the state opens up shots to millions more people next month, say Bay Area community clinic leaders and health officials. The state announced the change in vaccine eligibility on Thursday.
Making sure all communities have equal access will require more funding, staffing and vaccine — and not all of those are promised. Vaccine supply, or lack thereof, is particularly vexing.
Although Gov. Gavin Newsom projects weekly doses coming to the state will increase from 1.8 million to 2.5 million in the next several weeks and 3 million by May, counties and clinics have not been told whether that will translate to more doses for them and if so, how much and when.
“What’s been a challenge is that there’s been so much dialogue and so much said about moving forward and getting more doses and opening up. We haven’t seen that,” said Dr. Matt Willis, the Marin County health officer. “Our allocations are very similar to what they were a month ago. So it’s very nerve-wracking to hear the governor say it’s going to be open to everyone without any more supply.”
Clinic leaders say more funding appears to be on the way. The recently passed $1.9 trillion federal stimulus package includes $7.5 billion for state and local public health departments to expand community vaccination centers and mobile vaccination units in underserved areas.
One example: Asian Health Services, which provides health care to low-income residents in Oakland and this week completed a one-day vaccination event for 1,000 people, plans to use the money to buy a mobile vaccination van and hire more community health workers. They hope this will help expand vaccinations beyond their existing patients and reach others in the community, said CEO Sherry Hirota.
California has struggled to vaccinate residents equitably, despite state leaders’ concerted efforts to address disparities by allocating 40% of shots to low-income ZIP codes. A recent CDC report found that California ranks among the five worst states in vaccinating the poorest and most vulnerable residents. State data show Californians in the wealthiest areas are getting vaccinated at higher rates than the poorest areas — 42% are at least partially vaccinated in the former, compared to 28% in the latter.
Some worry that as vaccine eligibility opens up to more people, the same barriers that currently make vaccines hard to access for underserved communities — such as not having internet, or not having hours available to book an appointment, or running into language or transportation barriers — will get worse.
“I just worry that even more so, those who have access to booking those appointments online, those who have the luxury of time to keep trying and stay on the phone or repeatedly check a website throughout the day are those that are going to get signed up,” Dr. Michael Stacey, chief medical officer for LifeLong Medical Care, which operates clinics in Oakland and other East Bay areas.
“And we are going to leave behind people in the most vulnerable neighborhoods where they maybe don’t have the technology or the Wi-Fi connection or the time to just try and try and recheck and call,” he said.
Even when some vaccination sites are set up in high-risk communities, appointments can be snapped up by people outside those areas.
To get around that issue, when LifeLong held a one-day vaccination clinic in San Pablo last weekend, staff texted patients who live in San Pablo and Richmond and asked them to pass the word on to friends and family. They booked about 700 appointments ahead of time and left the rest open for walk-ins. Demand was so high that people started lining up at 4 a.m., Stacey said. In all, the clinic inoculated 1,000 people that day.
“We’d like to be able to do more events like that, that really target the neighborhoods that have seen the highest rates of COVID,” he said.
But holding similar vaccine clinics every weekend would require more funding for staff to administer shots and more vaccine, Stacey said. He plans to hire staff with funding that is slated to come their way, but he isn’t sure how much more vaccine will arrive in the coming weeks.
In some ways, expanding eligibility will remove barriers that could make vaccinating high-risk communities simpler and more efficient. For example, providers will no longer have to screen for someone’s age, job or underlying conditions.
“I’m really excited about the expansion,” said Dr. Lynne Rosen, clinical vaccine lead for La Clinica, which has clinics in Oakland’s Fruitvale neighborhood and dozens of other East Bay locations. “Being at a place where you can take a mobile van into a community, park at a church or school and anyone can walk up to get a vaccine, with no screening ahead of time, is a really nice model.”
The state also announced a new policy this week that allows providers in lower-income areas to vaccinate family members who come with an eligible relative to a vaccine appointment. That’s a “great idea” to improve access, Rosen said.Health Equity
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“It makes so much sense to vaccinate family units at the same time,” Rosen said. “So we’re not asking them to make multiple trips over weeks when they become eligible. You can do transportation once, show up and get everyone vaccinated. That’s a much more family-friendly model.”
As many more people become eligible and rush to get their shots, prioritizing those in the highest-risk areas will help everyone, not just underserved communities, said Stacey of LifeLong.
“Even if it’s available to everybody, I still think there are parts of the Bay Area and parts of California that should still get it first,” he said. “Both from a standpoint of equity and quite honestly, by targeting the neighborhoods that are most impacted it’s also the way to most effectively stop transmission and keep cases from growing again. … So if we can stop transmission in these communities it will actually have a bigger benefit for everyone.”