What Will a Third Vaccine Mean for Equitable Access to Immunizations in California?

Stories that caught our attention

Nurse delivers COVID-19 vaccine to patient at mass vaccination site
Brianna Borja, RN, administers a dose of Moderna vaccine to Etienne Dyiana, RN, at a Riverside County COVID-19 vaccination center for people in Phase 1B, on January 14, 2021, in Corona, California. Photo: Watchara Phomicinda / Orange County Register via ZUMA Wire

The FDA has approved Johnson & Johnson’s application for emergency authorization to distribute a new vaccine that blocked COVID-19 infections for 73% of people in US clinical trials and prevented either hospitalization or death for 86%. This will be the first single-dose COVID-19 vaccine available to Americans. It does not require storage at ultra-low temperatures.

Essential CoverageThe new vaccine could be a significant benefit to vaccine equity efforts, because it allows conventional transportation, storage, and administration of vaccine doses at far-flung vaccination sites lacking special equipment. And a one-dose regimen better serves people who cannot easily schedule two vaccine appointments during their regular work hours. Governor Gavin Newsom said the Biden administration plans to send California 380,000 J&J doses this week.

In California, 15.2% of the population has received a first dose of the vaccine, which is a slightly faster pace than the national rate of 14.6%. The California Department of Public Health recently released a COVID-19 Vaccine Dashboard that tracks vaccine distribution by race and ethnicity across the state. Some public health advocates are concerned that the dashboard indicates inequitable access to the vaccine for the groups most affected by COVID-19.

Nearly 13% of vaccine doses were administered to people whose race or ethnicity is listed as “unknown,” meaning the information is missing or they declined to state their race or ethnicity. Another 11% of doses were administered to people who don’t fall under any listed race or ethnicity, and they are categorized as “other.”

“Even with the data gaps, I think it’s clear that California is following the national trend of under-vaccinating our Black and Latino communities,” Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network, told Alexandra Yoon-Hendricks in the Sacramento Bee. “We really need to focus our efforts as we begin to ramp up, building up trust and overcoming barriers to access in getting those vaccines.”

California is currently vaccinating phases 1A and 1B, which include, among other groups, health care workers, long-term care residents, and people who have reached age 65. Those categories are disproportionately composed of White Californians, which may be contributing to vaccination disparities. For example, among health workers, 32% of California physicians are White, compared to 5% Latinx and 3% Black. Because more than half of older Californians are White, that could be influencing racial disparities in vaccination rates, CalMatters reported. Other contributing factors include limited vaccine supply, provider access issues, and ineffective control over the state’s vaccination appointment system, enabling people to register out of turn.

Demand Outstripping Supply

At a February 22 press conference at a vaccination site in Long Beach, Newsom noted that the site was running at one-third capacity because of limited vaccine supply. That week, California received about 1.4 million doses. Though vaccine manufacturers are working to increase production, complex challenges such as supply chain shortages abound.

Limited vaccine supply makes it especially difficult to prioritize communities that have been disproportionately harmed by COVID-19. In the Boyle Heights neighborhood of Los Angeles, Clínica Monseñor Oscar A. Romero serves 12,000 patients, many of whom are Latinx or indigenous people from Mexico and Central America. Clínica Romero recently received 100 doses of the Moderna vaccine after weeks of waiting, Cindy Carcamo reported in the Los Angeles Times.

“We serve the most hard-hit community in Los Angeles,” Carlos Vaquerano, executive director of the clinic, told Carcamo. “They are essential workers who are getting sick and dying at a higher proportion than anyone else in the county.”

Obstacles on All Sides

Vaccine supply problems have been exacerbated by severe winter conditions across much of the country. According to the White House, recent storms delayed the distribution of six million vaccine doses.

Responding to states’ complaints that limited vaccine shipment forecasts have hobbled their planning abilities, the Biden administration recently said it would try to provide states with longer-range estimates for vaccine shipments, Rachel Roubein reported in Politico.

At the individual level, lack of “technology, transportation, and time” can hamper vaccine access, Anthony Wright, CEO of Health Access California, told CalMatters. Navigating the state and county appointment systems require a computer or smartphone, internet access, and basic technology competence. Non-English speakers may also experience a language barrier, because some appointment websites are written only in English. (In Alameda County, The Oaklandside and its reporting partner El Tímpano are providing English and Spanish text updates about the vaccine rollout.) A recent Kaiser Health News investigation found accessibility issues on numerous COVID-19 appointment and information websites at the federal, state, and local levels that could hinder people with visual impairments to register for the vaccine.

Someone who has made an appointment may then need a car to get to the vaccination site. If the person is headed to a big center like Dodger Stadium in Los Angeles, the wait could last hours. Some people have waited as long as five hours at Dodger Stadium for their shot, Manny Fernandez reported in the New York Times.

Newsom has acknowledged these issues and is pushing the state to bring the vaccine to communities that might not otherwise have easy access. “We recognize our responsibility to do more,” he said recently at a mobile vaccination clinic in Inglewood. “We’re focusing on farmworkers. We’re down at Coachella Valley on an equity coalition collaborative focusing on farmworkers and pop-up sites in partnership with ranchers and with farm managers.”

Promotores, or Spanish-speaking community health workers, can also help reach “those who do not have easy access to transportation or to a computer, and those who don’t have time to call and schedule an appointment because of work,” Alexandra Mendoza reported in the San Diego Union-Tribune.

Appointments Out of Turn

A state equity program intended to help residents of underserved Black and Latinx communities secure vaccine appointments has been misused by outsiders, Julia Wick reported in the Los Angeles Times on February 22.

State officials gave community organizations like nonprofits, faith-based groups, and labor unions special access codes for the My Turn vaccine-scheduling website. The community organizations then distributed those codes to their members for appointments at vaccination sites in Los Angeles and Oakland. However, the codes “have been circulating, in group texts and messages, among the wealthier, work-from-home set,” Wick reported. “Many of those people are not yet eligible for the vaccine under state rules.”

It’s unclear how many doses were given to people who were not yet eligible to receive them. “Many people who used the access codes said they didn’t know they were doing anything wrong, and said they would not have signed up if they had known the codes had been earmarked for more vulnerable residents,” Wick, Maya Lau, and Laura J. Nelson wrote in the Los Angeles Times.

After learning about the problem, the state canceled appointments made with at least one of the access codes. The state will begin issuing individualized codes instead of group codes, Vivian Ho reported in the Guardian.

Meanwhile, Newsom said that California is beginning to see light at the end of the tunnel. The J&J vaccine arrives as the state experiences a significant drop in COVID-19 cases and hospitalizations after months of a regional stay-home order and the beginning of the vaccine rollout campaign. Multiple counties are expected to move from the purple tier, the most restrictive tier in the state’s color-coded system for reopening, to the red tier this week.

Starting next week, journalist Heather Tirado Gilligan will be taking over CHCF’s Essential Coverage report. As always, you can still reach me via Twitter or email. Please join me in welcoming Heather!