As Santa Clara County graduated to the state's less-restrictive "orange tier" for reopening this week, local health leaders cautioned that a drop in COVID-19 vaccine allocations from the state is jeopardizing their efforts to send doses to the most vulnerable parts of the county. A just-signed agreement with the state will give the county more flexibility to distribute its vaccine allocations where they are needed, however.
The county's vaccine distribution effort has been complicated by notices some county clinics received from the state's third-party administrator, Blue Shield of California, which threatened to withhold vaccines if they fail to sign a memorandum of understanding (MOU) with the private organization.
An example of an email from a Blue Shield representative sent recently to a local community health center, which was released by county officials, states: "The Third Party Agreement (TPA) (Blue Shield of CA) is working very hard to ensure there is no disruption to your organization in vaccine allocation. However, if you are an independent provider (meaning not county-owned) and wish to continue receiving uninterrupted first-dose vaccine allocations, we will need an executed TPA agreement no later than Tuesday, March 23.
"What happens if you decide not to move forward with the TPA agreement and are currently receiving vaccines? We will continue to work with each LHJ (local health jurisdiction) to ensure that you have ability to finalize second doses.
• It is possible that you may no longer receive first dose allocations effective April 1, 2021.
• The State using the TPA's recommendation (developed in partnership with each local health jurisdiction) will begin allocating vaccines directly to those providers that are contracted with the TPA by no later than April 1, 2021.
• The State using the TPA's recommendation will begin allocating vaccines directly to the Counties (for those entities that are county owned/operated) by no later than April 1, 2021.
• If you have relied on the County for your allocation thus far, please note that this will no longer be an option on or after April 1, 2021."
During Tuesday's Board of Supervisors meeting, County Executive Jeff Smith called the emails "distasteful at best." He said the county was seeking to enter into a revised memorandum of understanding with the state and not with Blue Shield, as Los Angeles County was recently granted, which allows the county more flexibility.
On Monday, Santa Clara County and the counties of Alameda, Contra Costa, San Francisco, Marin and Napa signed a joint letter to California asking to follow the template the state agreed to with Los Angeles County. California has agreed in an MOU to allow Los Angeles County to work jointly with Blue Shield on recommendations regarding vaccination allocations and to jointly receive communications from the state. The memorandum also allows for the transfer of vaccines between entities within the county, freeing up the county's ability to best serve its most vulnerable populations, County Counsel James Williams told the Board of Supervisors.
On Wednesday, that amended memorandum was signed by state and county officials. The county now has direct input into the suggestion process Blue Shield has with the state regarding vaccine distribution and has more control over vaccine allocations to be sent into its most vulnerable communities. The county will also be able to transfer doses from one health care entity to another as needed.
On Wednesday morning, the county canceled a press conference to address its concerns about Blue Shield's threats to the community clinics, many of which are in the hardest-hit areas of the virus and serve ethnic and racial minorities. Supervisor Cindy Chavez's office said the county entered into a "settlement in good faith" with the state, which allows the county and the clinics to sign an MOU directly with the state and not Blue Shield. The MOU contains the same addendum as the one between the state and Los Angeles County.
The agreement will allow the county to partner with Blue Shield but the county will work directly with the state to get the vaccines and won't have to sign the agreement with Blue Shield, Chavez said in a phone call on Wednesday.
"The most important thing is we can subgrant the vaccines to community clinics that are part of our network," she said.
Under the Blue Shield memorandum, counties were not allowed to transfer doses to health partners in need, hampering efforts to focus on communities most impacted by the virus. They can also be distributed to large venues such as at Mexican Heritage Plaza and Levi's Stadium, which are in the county's network, she said.
The county also isn't required to use the state's system for residents to sign up for their vaccine appointments until it becomes more functional, she said.
"We are very excited because we will have the ability to get everyone in the county vaccinated, even if they are hard-to-reach corners. We benefit from our partnerships with the clinics and their ability to reach deep into the community," Chavez said.
The MOU agreement doesn't change how much vaccine comes into the state or when it arrives, Chavez said. That's a larger issue. The trend in overall vaccinations by the county health system and first and second doses decreased this week due to continued issues with allocations by the state, county leaders told the board Tuesday. The county has not been included in the list of 400 prioritized areas for receiving vaccines.
State officials have designated 40% of vaccines to be administered in ZIP codes in the lowest quartile in the California Healthy Places Index to reduce disparities and target the hardest-hit communities. Many larger Bay Area counties such as Santa Clara County were not included in the list because the state's methodology averaged populations in mixed ZIP codes. Residents who are in heavily impacted communities and who share a ZIP code with wealthier neighborhoods were not factored in, county officials said earlier this month.
The county's efforts to distribute vaccines to areas it has determined are most in need is being jeopardized by the state's existing system, Smith said.
The seven-day average for administered first doses of the Pfizer-BioNTech and Moderna vaccines has plummeted to 911 that the county has given compared to more than 5,000 doses two weeks ago. The number of second doses remains relatively flat. The seven-day average total for all doses, including the single-dose Johnson & Johnson vaccine, has dropped from a high of about 8,000 two weeks ago to 5,118, according to county data.
While the county's allocations have slid, doses allocated to Kaiser Permanente have finally risen. The county had appointments for more than 22,000 Kaiser patients in earlier weeks after the health care giant experienced a severe shortage of vaccines. As the number of allocations changed, the county sought to transfer vials of extra vaccines from Kaiser to its county-run facilities to accommodate those Kaiser patients it had taken on. The state's third-party administrator, Blue Shield, refused to allow the transfer, which is prohibited under current rules, Smith said. That forced the county to engage in a cumbersome transfer back to Kaiser of the 22,000 appointments so that patients would receive their shots there.
The amended MOU should help to remedy the problems insofar as it allows the county to make adjustments to where the doses are to be distributed to aid its most impacted communities.
Meanwhile, county health leaders said they are seeing a flattening of the trajectory of COVID-19 cases rather than a continued decline that could presage another spike.
Health Officer Dr. Sara Cody said she is hopeful that if there is another surge, it might not be as severe because more people have been vaccinated, but she cautioned that there are many unknown variables, including the rise of variants of the deadly virus that are known to make people more sick.
Cody told county supervisors on Tuesday that the region is "not out of the woods" yet and should continue to take precautions that public health leaders have recommended throughout the pandemic: wearing masks, staying at least 6 feet away from others, washing hands frequently and limiting gatherings in large groups or with others outside of their household.
The county has now vaccinated 69.1% of residents ages 75 and older with at least one dose and 66.2% of residents ages 65 and older with at least one dose, county COVID-19 testing and vaccine officer Dr. Marty Fenstersheib said at the board meeting.
Residents living in the lowest quartile of the Healthy Places Index, which looks at factors including poverty that contribute to health disparities, still lag behind, with a test positivity rate of 2.7% compared to 1.2% for the county overall.
Among adults ages 75 and older who have received at least one dose of vaccine, 49.3% are African American, 68% are Asian, 41.3% are Latino and 62.6% are white. Among those ages 65 and older who have received at least one dose, 48.6% are African American, 71.7% are Asian, 41% are Latino and 58.1% are white.
When factoring in the entire population of residents ages 16 and older, overall, 28.2% have received at least one dose. Broken down further by race, the percentage comes out to 22.8% of African Americans, 28.4% of Asians, 15.9% of Latinos and 30.4% of whites, Fenstersheib said.
Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.