California’s coronavirus vaccination efforts are off to a slow start, with less than a third of the 1.6 million available doses administered so far, according to state officials.
Gov. Gavin Newsom acknowledged the rollout of inoculations has been too slow, and public health experts are growing concerned that the emerging vaccination delays may mean it will take longer to reach herd immunity and end the pandemic.
Officials and experts attribute the slower-than-anticipated vaccinations to many factors, and urge the public to have patience as health officials and hospitals work out the kinks of a campaign that is unprecedented in scale and urgency.
“It’s clear that this is a major and complex initiative, and all of us are learning as we go,” said Dr. Joshua Adler, chief clinical officer for UCSF Health, during a press briefing with San Francisco officials Tuesday. “What’s also clear is we need to increase the rate at which we’re able to deliver the vaccine to people.”
The administration of 460,000 doses by health departments and hospitals across California is roughly on par with the pace of vaccinations nationally, where approximately 4.8 million out of a total 17 million doses distributed have been used, according to the CDC. The state did not provide a breakdown of how many of those doses have gone to health care workers and how many have gone to residents of long-term care facilities.
Frustrations are growing that vaccinations for nursing home residents, who are at much higher risk of grave COVID-19 illness or death, and staff at those facilities have fallen behind schedule.
Vaccine supply, which gets allocated by the federal government to states, has been sporadic and often not finalized until the last minute — making it difficult for local health departments to plan when and where to administer the doses.
Complicating matters, some health care workers, who along with nursing home residents are in the first group eligible for vaccinations, are declining the vaccine at rates of up to 50% in some Southern California counties and health systems. It’s unclear what percentage of the health care workforce statewide is declining vaccine, Newsom said Monday, but the state is conducting a survey on the matter that it will release soon.
Also, it is taking some health care providers longer than expected to obtain the vaccine because they must register with the state, and the state does not always have enough staff to approve those requests right away, some local health departments said.
In some cases, the final dose in some vials — which contain several doses, and must be used within a certain number of hours once thawing begins — has gone unused. This is because certain vials come with “overfill,” or additional vaccine. Sometimes, that overfill is enough for an additional dose.
“We have some instances where folks have not used those final doses, and we’re trying to address that concern without putting people in a position where they feel like they’ve done the wrong thing,” California Health and Human Services Secretary Dr. Mark Ghaly said Monday.
And there may not be enough health care workers to administer the shots, in part because many hospitals are so busy staffing ICUs and emergency departments to care for COVID patients. This could worsen as larger groups of people become eligible to get vaccinated, and more people will be needed to administer the shots. The state on Monday moved to address this issue, announcing an emergency waiver to allow the roughly 36,000 dentists in California to administer the vaccine.
“If we’ve got to have a lot of our nurses and other health care workers in the emergency department in the hospital taking care of people, or testing ... we may have fewer people available to vaccinate,” said Janet Coffman, a professor of health policy at UCSF who researches the health care workforce.
Many long-term care facilities have been unable to obtain vaccines, while doses are sitting unused in warehouses for days because of technical and logistical issues, said Dr. Michael Wasserman, past president of the California Association of Long Term Care Medicine and medical director of the Los Angeles Jewish Home.
And once vaccines do arrive, it takes time to get consent from residents and their family members, sometimes because the consent form cannot be immediately accessed by the pharmacies administering the vaccines, said Wasserman, a member of one of the state’s vaccine advisory committees.
“Instead of going and vaccinating 10 people in 10 minutes, it may take an hour,” he said.
The start of the vaccination rollout also coincided with the holidays, so many workers took time off right as vaccinations at hospitals were starting to gear up and did not schedule their first doses until the new year.
“I really do think that we had perhaps overoptimistic expectations of a vaccination process over Christmas and New Year’s,” said Dr. Jay Luxenberg, chief medical officer of On Lok, a nonprofit that provides health care services to the elderly in San Francisco, Alameda and Santa Clara counties. “But my impression in all three counties we serve is those departments of public health have these things geared up and (are) doing a good job.”
On Lok’s 600 staffers in San Francisco are slated to get vaccinated this week and next week, with pharmacists from Chinese Hospital coming in to administer the shots. In Alameda County, where On Lok has fewer employees, staffers will drive to vaccination clinics to get the shots. The vaccines were actually available for San Francisco staff last week, but On Lok chose to push it back a week so it could obtain consent from staff and get them to sign up for vaccination slots.
Luxenberg said he is not seeing the high rates of health care workers declining to take the vaccine that some hospitals in Central and Southern California are reporting. About 90% of staff are signing up for the vaccine, he said.
“Our frustration is it’s so high that we may have underestimated the amount of vaccine” needed, he said.
Complicating the vaccine administration is that some of the shots are handled by local health departments or hospitals, while other distribution plans for long-term care facility residents are handled by a federal program partnering with CVS and Walgreens.
“Is it fragmented? Yes. But is it moving? Yeah,” Luxenberg said.
Dr. Kismet Baldwin, deputy health officer in Sonoma County, said that every county in the state is “experiencing some level of bottlenecks.”
She offered two examples. One involves getting providers registered with the state to deliver vaccine.
“That has slowed us down a little bit. It’s dependent on the state having enough staff to approve those requests to be registered,” she said. “That limits who we can distribute vaccine to.”
The other problem involves the county not getting much advance notification of how many doses it would receive each week. Baldwin said the county typically is told how many doses to expect about a week in advance, “but it’s not consistent.” And even a week doesn’t give authorities much time to figure out where the doses should go.
Vaccinations are progressing quickly in some facilities. Laguna Honda, the largest skilled nursing facility in San Francisco, began inoculating residents on Monday and expects to complete vaccinations for 90% of residents, about 650 people, by the end of Tuesday. That is higher than the percentage of residents who got the flu vaccine. Five residents have died from COVID-19, with the facility reporting the first deaths last week.
Dr. Nicholas Moss, the Alameda County health officer, said he thought the vaccine rollout so far has gone reasonably well in his county, given the circumstances.
“We have to set realistic expectations,” Moss said. “We’re all celebrating the speed with which the vaccine got here, and it’s really miraculous, the efficacy data. It’s great to be in this place. But the fact is that it only got approval less than a month ago and it’s very complicated to get this out as fast as people would like.”
Chronicle staff writer Erin Allday contributed to this report.
Catherine Ho is a San Francisco Chronicle staff writer. Email: cho@sfchronicle.com Twitter: @Cat_Ho
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