Despite months to prep, why California lags on vaccinations

No one ever said that distributing a vaccine to tens of millions of Californians spread out across 58 counties in the middle of a pandemic would be easy.

But Gov. Gavin Newsom came pretty close in October.

At a press conference on the 19th, the governor assured the public that California has “long been in the vaccination business.” That projection of confidence came just three days after the CEO of the pharmaceutical giant Pfizer announced the company would seek the regulatory greenlight for its new COVID-19 vaccine. California, the governor said, would be ready.

Roughly 19 million flu shots every year. The recent history of a mass Swine Flu inoculation program in 2009. An early partnership with the federal government to plan for the coming distribution campaign. A new “Logistics Taskforce” established within the governor’s Office of Emergency Services. The governor cited all this as evidence that “experience with vaccinations is well established here in the state of California.”

A logistical headache

More than three months later, the state is still scrambling to deliver. And the mammoth logistical headache of inoculating a state desperate for a return to pre-pandemic normalcy has become a pressing political one for Newsom. According to the most recent federal data, California is still sitting on 40% of its allotted vaccine, putting it in the bottom third of all 50 states. The messaging also has been hard to decipher, with information from the governor’s office sometimes at odds with that being issued by the counties.

With Newsom now facing an increasingly credible recall effort, the slow, sputtering vaccine rollout raises the question: Didn’t the state have a plan for this?

Originally yes, it did — although the governor’s Office of Emergency Service isn’t responding to questions about those early preparations. During that Oct. 19 press conference, Newsom said that a state logistics task force had been working on a vaccine distribution plan for months. Public health experts say the state’s initial approach was modeled on the tried-and-true approach it uses to distribute flu shots — a plan that placed the bulk of the administrative onus on county governments, with the state serving a standard-setting and advisory role.

In the past, giving local health officers that flexibility “has been very advantageous,” said Dr. John Swartzberg, an infectious disease specialist and professor emeritus at the UC Berkeley School of Public Health.

“Unfortunately, during a pandemic, that approach can make it very difficult to implement things. And I think the state has recognized that.”

So last week, Newsom announced Plan B: proposals that he promises will simplify and speed up the process of pumping out vaccines. What went wrong with the initial plan —  and shouldn’t the administration have anticipated these hiccups?

Many public health experts say most of the factors that have slowed the state’s inoculation plan are outside the governor’s control: California’s size and complexity, a fragmented public health care system spread over 58 counties, unsteady federal leadership and the challenges of transporting, storing and administering current COVID-19 vaccines.

But some of the hurdles may be of the administration’s own making.

The state’s initial distribution framework, which prioritized Californians by occupation group, underlying medical conditions and housing status, may have slowed the process by creating a system that was difficult to administer and hard for the public to understand.

And some critics bemoan what they see as the governor’s penchant for making vague, premature announcements prior to consulting those most affected.

Jeff Smith, executive officer for Santa Clara County, is one of those critics.

“For the past year, the entire approach that the governor has taken to the pandemic has been disorganized and petulant,” said Smith, who disagrees that county governments are sitting on unused vaccine. “Whenever he feels like he’s getting bad press, he does something. And the things that he does are not wise things and they’re not driven by scientific decisions,” Smith said.

A vaccine rollout that is unprecendented

No matter how much blame Newsom deserves, Democratic consultant Garry South said the governor is sure to get the lion’s share.

“I’ve seen this movie before,” said South, former campaign manager to Gray Davis, the only governor in California history to be successfully recalled. Davis, South noted, was booted from office in large part for his handling of the state’s electricity crisis in 2001. “The governor gets blamed not for the problem, but for not solving the problem.”

California is not the only state struggling. Vaccine production has been slower than many experts expected. Public health authorities say the outgoing Trump administration offered neither the guidance nor the necessary funding to states. The Pfizer vaccine must be stored at -94 degrees Fahrenheit, while the Moderna version can be kept at a balmy -4 F. Once thawed, both have a short shelf life.

“I would be hesitant to make any really strong judgments right now as to where things have gone wrong,” said Democratic state Sen. Josh Newman of Fullerton, one of roughly a dozen state Democratic legislators who get weekly Zoom briefings on COVID from the governor’s office. “It’s unprecedented (and) it’s inherently complicated.”

The complexity of the current vaccine campaign is ”a quantum leap” ahead of all of our other vaccination programs, said Swartzberg. “No one that I know expected it to go smoothly. And, you know, right now it looks like it’s gone just horrifically. But I think we’re really being granular, when — day by day — we critique it.”

It’s no coincidence that the states that seem to have had the most success in pushing out vaccines — West Virginia, the Dakotas — have populations a mere fraction of Los Angeles County’s and without nearly the linguistic and cultural diversity, said Jeff Goad, chair of the Department of Pharmacy Practice at Chapman University. He sits on the state’s Drafting Guidelines Workgroup, a panel of experts that help determine which groups should receive vaccines first.

“We’re in a class by ourselves,” he said.

In explaining the slow rollout last week, the governor likened changing policy to “shifting course” on a “large ship.” But given how fragmented the state’s healthcare system is, with vaccine distribution responsibilities split up among 58 county governments, nine multi-county hospital networks and at least half a dozen pharmacy chains, “it’s more like a flotilla,” said Anthony Wright, director of Health Access and a member of the state’s vaccine advisory committee.

The state’s early planning efforts were also the victim of bad timing, said Tony Iton, a senior vice president of the California Endowment. Vaccine deployment planning took place just as the state’s COVID-19 caseloads were peaking once again and hospitals in Southern California were turning away ambulances.

“The very people you need to sit back and do the analysis and research and the planning are caught up managing the day to day issues related to the just incredible surge we saw over the winter,” he said. “I know the folks that are working up there (in Sacramento) are — they’re burnt. They’ve just been running full speed for a year, and humans can’t take that.”

The governor’s early optimism notwithstanding, none of these hurdles were lost on those inside the Newsom administration this winter.

Six months = 300,000 shots a day

In a mid-December podcast produced by the Office of Emergency Services, Grady Joseph, assistant director for the state’s COVID-19 Logistics Task Force, predicted that the vaccination campaign would make the state’s earlier organizational struggles to buy and distribute personal protective equipment and ramp up testing “look fairly trivial.”

“If you want to vaccinate everybody within a six month time period, assuming you have the supplies and the vaccine, we have to do an excess of 300,000 vaccines a day,” said Grady. “If you compare that to the amount of COVID testing we’ve done, some of the highest days we’ve ever had have been 215,000.”

On Monday (Feb. 2),  the state administered a little over 167,000 doses, according to data collected by the Los Angeles Times.

The overhaul of the state vaccine plan announced over the last two weeks are intended to speed up the process.

On Jan. 22, the state launched a website where anyone in the state can sign up to be notified when they are eligible for a vaccine. Up until then, confused and anxious Californians seeking information would often ping pong between their county, providers and insurers.

The governor also announced that the state would hire Blue Shield to coordinate where vaccines will go and to gather data on distribution.

CalMatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.