Health and Equity Experts Grade California’s Vaccine Rollout

On Thursday morning, Gov. Gavin Newsom rolled up his T-shirt sleeve and got vaccinated, marking the start of what he has described as the final stretch of an epic race to inoculate as many Californians as possible against the coronavirus.

The governor, who is 53, was newly eligible under the state’s vaccine rules, which as of the start of the month allow anyone 50 and older to be vaccinated. And on April 15, in conjunction with a flood of supply promised by the Biden administration, eligibility will expand even further, to anyone 16 and older.

“We have an enormous opportunity in the next six to eight weeks to run the 100-yard dash,” Newsom told reporters Thursday during another news conference at a vaccination site, this time in Los Angeles. “We’re this close.”

But the triumphant pronouncements and dazzling raw numbers—more than 18 million shots have been given to almost a third of California’s population—gloss over a messier reality.

From almost the first day that shots were administered in the state, Dec. 14, the vaccine rollout has been dogged by a certain amount of confusion: There have been abrupt rule changes. And an opaque, multimillion-dollar contract with Blue Shield of California to manage the state’s vaccine rollout prompted an outcry from local officials, some of whom have suggested that Newsom’s fear of being recalled was driving his decision-making.

Ultimately, though, how much has all of that affected the state’s outcomes?

I wanted to simplify the conversation. So I reached out to a dozen epidemiology, public health and equity experts throughout California and outside the state, and asked them to grade the state’s vaccine rollout and explain why.

The average grade they gave? B-

Nearly every expert I reached by phone or email in the past couple of weeks acknowledged the monumental nature of the task. But they also said that, like a capable student with clear advantages, California has a lot of room for improvement.

“California gets a C from me, the same grade I would use for a student who is engaging but could be doing much better with more effort and better study strategies,” said Dr. Alicia Fernandez, a professor of medicine at the University of California, San Francisco, who specializes in Latino and immigrant health.

Andrew Noymer, a professor of population health and disease prevention at the University of California, Irvine, gave the state’s rollout a C, emphasizing that it was a “midterm, not a final.”

In many ways, he said California and other states had made the vaccination campaign overly complicated; more people in the United States are inoculated for the flu every year, he said, “without the Sturm und Drang that has accompanied the Covid vaccines.”

Dr. Christopher Longhurst, UC San Diego Health’s chief information officer, gave the rollout a B-, largely because successful partnerships between public health departments and health systems have been hampered by the extra bureaucracy built into the state’s deal with Blue Shield.

“The transition to a vaccine allocation process overseen by Blue Shield was unwelcomed by county leaders and health systems alike and continues to operate with very little transparency,” he said.

By far, though, the biggest concern was that California hasn’t come close to meeting its lofty equity goals, which Newsom has repeatedly described as “a North Star,” guiding the state’s work.

Early on in the vaccine campaign, experts debated whether California’s strict prioritization of vulnerable populations and workers meant sacrificing crucial speed.

Advocates, however, have said that both should be possible, especially in a state like California, where officials are well aware of the state’s health and economic divides.

“Equity and scale are possible for the wealthiest states in the nation,” said Jacqueline Martinez Garcel, chief executive of the Latino Community Foundation, who gave the state’s rollout a C+.

As supply has increased, the conversation has shifted to focus on the best ways to ensure that a fair share of doses actually gets to residents of the hardest-hit communities, which are often, not coincidentally, among the hardest to reach—rather than being snapped up by wealthier, more tech savvy white Californians.

Dr. Kim Rhoads, a community engagement expert at UCSF, gave the rollout a C-, because even the state’s well-meaning equity efforts, like a loudly promoted move to direct 40% of new doses to ZIP codes considered most vulnerable, don’t address the nuanced concerns of Black and Latino Californians.

“Most things in health care and dare I say public health are geared toward the majority population,” she said. “They’re not intentionally designed to address the issues in Black and brown communities.”

For example, she said that the state’s approach—dropping a vaccination clinic in a poor ZIP code—left out Black Californians, who have a history of being displaced and dispersed across cities.

The state’s apparent preference for big contracts to manage the vaccine campaign is frustrating for Rhoads and colleagues with community organizations, who already have relationships with the people the state is trying so desperately to find.

“We don’t see this so-called hesitancy at our pop-up sites,” she said, referring to her work with Umoja Health, a group that has brought testing, resources and, more recently, vaccines to communities of color in Oakland during the pandemic. Rhoads said that’s because the sites not only eschew complicated online sign-up systems, but they also are staffed by people whom community members are more likely to know.

And community organizations are more nimble—the better to adapt to rapidly changing supply constraints or other shifting conditions.

“It’s about bringing assets to the table, rather than staying in our same frame,” she said.

Still, many of the experts granted that, just as things could be better, they could also be much worse.

In terms of the state’s share of the population that’s been fully vaccinated and other broad measures, California is “squarely in the middle of the group of 50 states and close to the national average,” said Dr. Lisa Cooper, director of the Johns Hopkins Center for Health Equity, who gave the state’s rollout a C.

Cooper added that California was “slightly better than average in the Black-white and Latino-white disparities among those vaccinated.”

She said she expected to see the state improve to a B, “provided they don’t get bogged down in technical challenges related to their appointment system and administrative issues related to working with a private contractor.”

Dr. Sandra R. Hernández, president and chief executive of the California Health Care Foundation, gave the state kudos for getting rolling at what she described as a record pace.

6 Comments

  1. Let me point out that many states are already vaccinating everyone. Where I live, most over 16s can get a vaccine …there’s a mass vaccine clinic this weekend at an airport parking lot for those over 16. Appointments still available today.
    I am thinking that California has over engineered this all. Or over equitied it. Not sure.

  2. From what I can tell, the vaccine has not been equitably distributed around California. For example, if you are willing to make a long drive, right now anyone over age 16 can get vaccinated at the CSU Bakersfield mass vaccination site. They are apparently begging people to come because they are swimming in vaccine than the locals don’t want. Appointments are also widely available at pharmacies (CVS, Walgreens, Rite-Aid, etc.) in Fresno and other locations in the Central Valley. I know several people from the Bay Area who have driven to Fresno or Stockton to be vaccinated in the past week.

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