Supervisors to consider requiring health care systems to provide vaccination plans

UPDATE: By a unanimous vote, the Santa Clara County Board of Supervisors supported a proposal for large health care systems in the county to provide written plans and timelines for COVID-19 vaccine distribution at its Jan. 12 meeting.

—

Santa Clara County’s Board of Supervisors will consider directing staff to create an urgency ordinance on Tuesday that would require large health care systems to produce a written plan and timeline for administering the COVID-19 vaccine to county residents. The administration and County Counsel would present the board with the ordinance at the Jan. 26 meeting.

The goal of the ordinance is to bring the county’s health care sector, including private hospitals and clinics, on board so officials have a comprehensive view of how many vaccines are being given out, to whom and when.

The ordinance would augment a Jan. 7 Public Health order that requires vaccination providers in the county to share information on an ongoing basis and to prepare vaccination plans by Feb. 1.

Under the health officer’s order, large health care systems must submit comprehensive plans that include: how they intend to provide vaccines to all of their primary care patients as they become eligible; how they will create vaccine-administration sites; communication plans to inform their patients when and where they can receive vaccines; the anticipated number of vaccine appointments; and a timeline for achieving the full vaccination of their patients and how they will avoid “wasting” vaccine doses when there are not enough patients receiving them within a designated tier on any particular day.

Supervisor Joe Simitian, who chairs the board’s health and hospital committee, and board President Cindy Chavez said during a webinar on Monday that they want to be sure the currently fragmented protocols for various health sectors are brought together.

The health care entities would be required to share these plans with the Board of Supervisors and the public. The plans would include information on how people will find out about their ability to get vaccinated, and how vaccines will be distributed. The medical facilities also would have contingency plans for unexpected situations, such as broken freezers or extra doses of thawed vaccines so that they can be administered before they expire.

Simitian and Chavez said they are also concerned that many people might fall through the cracks even with the individual health providers’ plans. The urgency ordinance would include requirements for plans related to people who don’t currently have a health care provider — the “missing middle,” Simitian said.

The supervisors said they wanted to avoid the problems they saw with the COVID-19 testing, when there were months of back-and-forth discussions that slowed down the ramp up.

Not all health care providers approached the same requirements equally, requiring a mandate from the board to test patients. Simitian said he hopes the same won’t happen with the vaccines. Unlike the testing, health providers are used to giving vaccinations as part of their overall mission; they didn’t always see testing as part of their responsibilities, he said.

“Given the dire state of the pandemic and the hope for vaccination, our health care systems cannot afford to repeat these patterns. We recognize that large health care systems could play an even greater role in vaccine distribution, and detailed plans and timelines that are public and coordinated can reduce confusion, instill confidence and, most importantly, get the job done in a timely, fair, efficient, and life-saving fashion,” Simitian and Chavez said in a joint proposal to the board.

“We can’t afford to lose a month; we can’t afford to lose a week; we can’t afford to lose a single day,” Simitian added on Monday.

Without coordination and tracking, the state’s current patchwork system creates potential disparities in the quality and quantity of information provided to the public and risks inconsistent or incomplete rollout of vaccinations, the supervisors said

Entities with a nexus in multiple counties, such as Kaiser Permanente and Palo Alto Medical Foundation, for example, receive their vaccine allotments directly from the state; hospitals in the Veterans Affairs Health Care System receive the vaccines through the federal supply chain; CVS and Walgreens drug stores administer the vaccines at skilled nursing and long-term care facilities for the Centers for Disease Control and Prevention; and private and nonprofit providers, such as Stanford Health Care and El Camino Health, receive their vaccines from the county.

“We need a very rigorous framework so people know when it’s their turn to get vaccinated,” Chavez said.

Simitian noted that the state’s seven phases and tiers for rolling out the vaccine have also created challenges. “People should not be waiting for the last person in a tier” to start receiving their vaccine, he said.

On Monday, Gov. Gavin Newsom said the state is addressing some of these concerns, noting that state health leaders are working to expand the pool of recipients and the tiers so that there will be a smoother and more rapid rollout. The state expects to reach its 10-day goal of 1 million administered vaccines by this weekend, he said.

The state and the county are also setting up more mass testing sites. Santa Clara County has a site at the county fairgrounds and has had a number of offers, including from Levi’s Stadium, to set up more, Chavez 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.