Of the more than 200 questions received ahead of the Monterey County Covid-19 vaccine town hall held virtually on Jan. 14, the one at the top was predictable: “When can I get vaccinated?
That is the question of the moment, and there is no easy answer. Vaccine supply is low. The rollout has been marked by disconnects, missteps and miscommunications – real or perceived – up and down the chain from federal to local officials. The result is the appearance to the public that there is no well-thought-out plan in place. There are, in fact, people behind the scenes making plans, but that isn’t always relayed well. Add to that a very fluid and dynamic situation, in which information about the virus and vaccines changes sometimes by the hour.
“From the beginning, the community has been desperate for information about who is in charge, who is making decisions and where they fit into the plan,” says Wendy Root Askew, chair of the Monterey County Board of Supervisors. She has received dozens of calls, texts, social media messages and letters from anxious constituents in recent weeks. “They’re asking urgently to know what’s going on.”
The public wants to know why the rollout is taking so long. There is blame cast toward county officials, but the reality is that the causes extend all the way to the top of the federal government amplified by failures in the Trump administration. In the middle is the state of California, which makes public pronouncements with little to no warning to county officials, leading to more confusion. It’s going to take some time for a clearer plan to come into view.
“We have to acknowledge this is really frustrating for everyone: For our community members trying to get their loved ones vaccinated; our county Health Department staff working around the clock since the pandemic started; the state public health team that’s been uninvested in for generations; and the federal government that wasn’t ready to deliver on a Covid-19 response,” Askew says. “Without forgiving or making excuses for how it’s been happening, we have to keep our eye on the goal of getting people vaccinated as quickly as possible.”
To reach herd immunity, the county has to get through three phases in the state’s guidelines to vaccinate 80 percent of the county’s population. That’s an estimated 347,200 people of the roughly 434,000 people who live here.
As of the town hall on Jan. 14, fewer than 12,000 people had been vaccinated. But this statistic is also murky – the state’s tracking system is failing to give even the Health Department an accurate number.
Although Monterey County Health Officer Edward Moreno and others tried to answer questions during the town hall with an upbeat and hopeful tone, the answer to the big question – when can I get vaccinated? – boiled down to a less hopeful response: They don’t know.
IT’S NOT JUST MONTEREY COUNTY where vaccines have been rolling out slowly, it’s the entire country.
As of Jan. 19, 31.1 million doses have been distributed to states and U.S. territories but only 12.2 million people have received their first dose of the two-dose regimen, according to the U.S. Centers for Disease Control Covid-19 data tracker. This, despite promises made by the Trump administration that Operation Warp Speed would deliver 300 million vaccines by the end of December and 80 percent of the country would be vaccinated by late June 2021. Instead, only about 20 million doses were delivered in December with an estimated 2 million people vaccinated.
California was in the bottom fifth in distribution among states and territories as of last week according to Bloomberg’s Covid-19 Vaccine Tracker, with 26 percent of its 3.5 million doses administered. (West Virginia was number one, at 37 percent.) This week California is in the lead, using 39 percent of the 3.5 million in stock. As of Jan. 19, there is no publicly available database showing the vaccination rates of each California county. That makes it hard to gauge how Monterey County is doing in comparison. There is anecdotal evidence that other counties are moving through the tiers at a faster pace, but Moreno told the Board of Supervisors on Jan. 12 that he cannot get accurate numbers from the California Inoculation Registry (CAIR2), which tracks the number of vaccinations statewide.
During the town hall, Moreno said the county had received 24,150 doses. Numbers from CAIR2 showed 8,600 people vaccinated so far. Big problem: The county hospital, Natividad, showed only one vaccination given, according to CAIR2. Natividad officials reported to Moreno they’d actually given 2,980. Using CAIR2’s numbers, Monterey County had administered 35.6 percent of its stock as of Jan. 14. Add in Natividad’s number, and Monterey County’s percentage shoots up to 48 percent.
Even adjusting for the data errors, that still leaves more than half of vaccines delivered so far in freezers around Monterey County.
THERE ARE CHALLENGES that make it hard to keep vaccines rolling out quickly. At the top of the list at the moment is supply – there isn’t enough vaccine coming through from the federal government to the state to the county, and delivery is inconsistent.
“It’s really problematic right now because we don’t have a consistent supply of vaccines coming into Monterey County,” county Epidemiologist Kristy Michie says. “Sometimes we only know a day or two in advance.”
It makes planning future clinics impossible. For now, what’s left in the county’s inventory is scheduled for clinic appointments reserved by health care workers, Moreno said. The county has an estimated 22,000 health care workers, accounting for nearly all of the 24,150 doses that have already been received from the state.
The day after the county’s virtual town hall meeting, incoming President Joe Biden announced an aggressive plan to get 100 million vaccine shots into the arms of Americans by his 100th day in office. He proposed $20 billion for a national vaccine program that includes community vaccination centers. Biden acknowledged the shortages his administration was inheriting, and said things would get worse before they got better.
It’s not just inconsistency of supply, it’s inconsistency of messaging, or lack thereof. Throughout the pandemic, Gov. Gavin Newsom and the California Department of Public Health have made announcements with little or no warning to counties. A prime example came Jan. 13, when Newsom announced everyone age 65 and older should get a vaccine as soon as possible.
The county’s response: It’s not possible.
“It would be a challenge for us if the state and federal governments do not give us more vaccine,” Moreno said shortly after Newsom’s announcement.
The flurry of media around the governor’s proclamation led to so much public interest, local governments were pushing out their own announcements to say that despite the sweeping new guidance for those 65 and older, in Monterey County they will have to wait until after health care workers are vaccinated.
IN THE CACOPHONY OF PANDEMIC and political news inundating the U.S. in 2020, some of the finer points of how decisions were being made about who would receive vaccines and in what order got buried.
“That’s not been really as well explained as it might be and people are confused,” says Bernard Lo, a doctor and director emeritus of UC San Francisco’s program in medical ethics. He serves on California’s Drafting Guidelines Workgroup, the committee tasked with developing the vaccination guidelines for the state.
Using the CDC’s guidelines, the 16-member workgroup further teased out phases and tiers, which Monterey County closely follows.
Lo says at the beginning, the group focused on those at most risk for contracting Covid-19 – frontline health workers in hospitals – and those at greatest risk of being hospitalized and dying from the virus, including nursing home residents.
“I think it’s fair to say the rollout has been mixed,” Lo says. He points to reports of hospital employees with no direct patient access (like administrators and parking attendants) getting vaccinated during Phase 1a, although that the group was placed in 1b. Here in Monterey County, 2,324 Montage Health employees received their first dose in December. (Montage is the parent nonprofit for Community Hospital of the Monterey Peninsula.)
Montage spokesperson Brenda Moore says it was acting on verbal instructions from CDPH in multiple statewide calls with hospitals, and that guidance was confirmed verbally by the county Health Department.
“The guidance was to begin vaccinating personnel at higher risk and then work our way through the workforce. We followed that process, issuing invitations first to those at higher risk and scheduling people as they responded,” she says.
Montage is currently partnering with the county to conduct clinics for health care workers from the broader community.
“We’re making plans to continue vaccinating more people as vaccines becomes available,” Moore says. “We share the frustration many people have about the limited availability of vaccine and the slow rollout.”
The disconnect between what was intended by the workgroup and the actual rollout was not lost on the public. That “leads to mistrust and cynicism,” says Lo, and a sense that there’s a lack of fairness. “We need to admit things have not gone well and we have a lot of improvements we need to go through,” he says. “People can accept waiting longer, if there’s a plan.”
FOR LONGTIME PUBLIC HEALTH WORKERS like Andrea Zoodsma, VNA’s director of community services, administering Covid-19 vaccines is like taking a football team to the Super Bowl. They’ve been practicing their entire careers, administering thousands of vaccines for everything from flu to pneumonia, hepatitis to shingles. Zoodsma remembers how during the 2009 H1N1 pandemic, when vaccines were scarce, they had to hold a lottery to see who would get vaccinated first.
“We’re eager to be a part of it,” she says. Her team of 15 nurses have been vaccinated for Covid-19, in anticipation that they will be administering vaccinations to others. (Approximately 175 other VNA employees who see patients had not be vaccinated as of Jan. 14.) “We have our freezer in place and we’re ready to roll,” Zoodsma says.
The VNA is a part of the county’s plan for vaccinating more residents in Phase 1b and beyond, along with clinics at hospitals, urgent care clinics, primary care physician offices and pharmacies. On Jan. 15, Biden announced his plans for establishing community vaccination centers and creating mobile units to reach rural areas. As for large-scale events like those being done at Disneyland and in stadiums, county officials said during the town hall there isn’t enough vaccine in Monterey County yet.
Biden has said he would invoke the Defense Production Act if necessary, which could speed up the flow of Covid-19 vaccines to the counties tasked with giving shots in arms. For now, all Monterey County is offering is an online vaccination reservation portal.
“We collectively are making imperfect progress at a time when people are desperate for protection and for life to feel safe again,” says Askew.