State errors confound vaccine rollout in California, as Sacramento pleads for more doses

Each Tuesday, Sacramento County health officials await an email from the state alerting them to how many doses of COVID-19 vaccine they’ll receive — a number that helps local pharmacies and health officials organize the massive distribution effort.

So, Dr. Olivia Kasirye, the county’s health officer, was alarmed last week when she read that her team would receive just 975 doses — for a county with about 1.4 million people.

It was a mistake. California health care officials were overestimating the number of people over 75 who would get vaccinated by hospitals and undercounting the number of doses the county needed to farm out to smaller clinics and pharmacies, she told The Sacramento Bee on Thursday.

The error was another misstep in California’s sluggish effort to get the COVID-19 vaccine to health departments and hospital chains. As California ends its sixth week of administering vaccines, the jerky rollout has been mired in inconsistent data and changing rules.

And now, another vexing problem has created confusion and chaos. California is failing to clearly count and report how many people are receiving vaccines in each of the state’s six regions, The Bee has learned. The state appears to be overcounting vaccine distribution in the Bay Area, and undercounting the progress in the Sacramento region. The reality may be more balanced.

The state’s faulty data reporting about vaccine distribution is part of a recurring pattern during the pandemic that has hamstrung how officials and the public understand the disease’s spread and the path ahead, especially in vulnerable communities.

For many local health officials, vaccine distribution is still a guessing game.

“We were planning with pieces we didn’t even know we were going to have,” said Rachel Allen, Sacramento County’s immunization coordinator. “So I don’t think we’re surprised. It’s very challenging. We’re staying very flexible.”

At a time when pharmacies are clamoring for shots to vaccinate people in long-term care facilities and hospitals are seeking doses of their own, county health departments find themselves jockeying for their own spot in line.

After a back-and-forth last week, the state unlocked an additional 5,700 doses for Sacramento County, Kasirye said.

“I think they’ve since changed that calculation to make sure that public health does get enough because we pointed out that there are a lot of people who will not go to the hospitals and may not access the clinics,” Kasirye said. “We need to be able to provide that vaccine to them.”

This coming week, the county will get about 13,000 doses, which will be doled out to some 40 clinics. In an era of uncertainty about how much vaccine there is to go around, county health officials said they’re hopeful it’s the end of a series of data mishaps.

There is consensus among California counties that there simply isn’t enough vaccine.

Dr. Erica Pan, the state’s leading epidemiologist, on Wednesday said it could take until June for enough vaccines to get into the arms of Californians 65 and older unless the amount shipped to the Golden State increases dramatically. A boost in shot delivery could happen, she said, depending on new vaccines under review and potentially ramped-up production of existing ones under President Joe Biden’s administration.

For now, it’s a question of how to effectively use what has come in so far.

“Where and how can we have the most impact, but also respond to some of the feedback we have in the setting of very little vaccine for a huge state like this?” Pan said Wednesday during a state vaccine planning meeting. “And how can we have consistency across the state? We’ve been hearing a lot about confusion and certain places are moving more quickly than others.”

The dearth of doses is, in some ways, beyond California’s control. States from coast to coast are at the mercy of a limited supply, fragmented distribution and fractured communication about who will get how many doses and when. Plus, confusion abounds about why some officials are calling for all doses to go into arms at once while others — including California — insist on sticking to the plan of ensuring those who get the vaccine have access to both shots.

But the vaccine rollout is just California’s latest technological fumble during the pandemic. Last spring, the state was slow to publish details about which nursing homes and long-term care facilities had disease outbreaks. Reporting on jail hotspots, which can feed outbreaks across communities, didn’t happen in earnest until late summer. And technological problems with case reporting became a black eye for Gov. Gavin Newsom’s administration in August.

‘We do not have visibility on exactly what is happening’

Health officials statewide have administered about 1.6 million doses of the COVID-19 vaccine, or roughly 41 doses per 1,000 residents, according to the most recent data from the California Department of Public Health.

While the state provides the number of doses administered by region, the data paints a misleading portrait of what’s happening on the ground. Sacramento-area counties and those across the Central Valley, for example, appear to be administering vaccines at about half the statewide rate.

But health officials say that might be because hospitals, which have received thousands of doses for their employees at the front of the line, report the number of doses administered based on where the hospital chain is headquartered — not the region where the hospital giving the shots is located.

That means Kaiser Permanente’s numbers in the greater Sacramento region, for example, could be inflating the inoculation rate in the Bay Area, where the health provider is based.

“It’s become clear to us that we do not have visibility on exactly what is happening across the systems that are delivering the vaccines, and how it distributes out across the counties,” Dr. Tomás J. Aragón, the director of CDPH, said Wednesday.

For vaccines, the state also says it does not know exactly where 108,000 doses — or 9% of total doses administered — were given. CDPH said Thursday it is working on a public dashboard that will show more information about vaccine allocation and distribution, and that it will be available soon, but it is not ready yet.

“There is a big push and a big effort to really get the data systems improved,” Aragón said.

By comparison, some states have robust data dashboards tracking vaccine administration. South Dakota publishes an online report with county-level details about how many vaccines have been doled out and whether they are from Pfizer or Moderna. North Carolina has a similar county-by-county visualization and also publishes demographic details about who’s been inoculated by race, ethnicity and gender.

The problematic rollout and seeming chaos of the current moment are partly explained by the state’s complex network of systems working to get the vaccine into arms as well as some degree of self-inflicted error, The Bee reported last week.

Local vaccinators receive doses while the state marshals the process. But that network of thousands of vaccinators spans private medical clinics to complex and overworked county health departments. That translates to confusion about who is eligible for a vaccine and has spurred delays in reporting out data about how many people have been vaccinated.

California’s carefully prescriptive rules have also hindered how quickly vaccines get to the arms of people in need. And county health officials, who prepared in-depth vaccine playbooks months ago have essentially had to improvise on the fly.

“We are hearing it,” said Dr. Nadine Burke Harris, California’s surgeon general and a co-chair of the vaccine committee. “We are hearing all of the challenges with the current vaccine distribution system and we are working to improve it.”

“One of the most challenging things about responding to a novel pandemic with a novel virus,” she said, “is we have to work with the best information that we have.”

Consensus among health officers

As of Thursday evening, only five states reported having administered fewer vaccinations per 100,000 residents than California, according to data from the U.S. Centers for Disease Control and Prevention. That’s despite the state receiving more vaccines per 100,000 residents than about half of the states in the country.

Ranking which states were above or behind others by administration rates could be misleading right now, in particular, because of delays and differences in how states share data, said Dr. Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials.

It’s an artifact of longstanding problems in how local and state public health departments collect and report data. It’s the “biggest setback” and makes it hard to know which communities are being left behind.

“We know that if it’s first come, first served, the folks who have resources, folks who have connections are far more likely to get vaccinated than folks who don’t,” Plescia said. “We have to be very careful. We’ve already seen a huge disparity in the burden of COVID in low-income populations and populations of color. And if we don’t really pay attention, we’ll see the exact same thing repeated as far as the availability of vaccination.”

The system used by providers to obtain vaccines is convoluted.

California hospital systems, public health departments and other providers place orders for vaccines each week. Those orders are reviewed by the state and sent to the federal government, which authorizes the order and sends a request to the vaccine manufacturer. The manufacturer or a centralized distributor then ships the vaccine directly to the local provider.

In Placer County, interim health officer Dr. Rob Oldham said his staff has repeatedly scrambled to find enough vaccines to keep up with appointments, almost running out several times. On Tuesday, he said, the county had to borrow from a nearby hospital.

“So that’s where we are,” he said Wednesday. “We’re in vaccine debt now.”

Oldham said he is nonetheless not sure if other counties are getting a disproportionate share of vaccines, largely because data reporting on vaccine distribution has not seemed reliable.

“I can’t speak for LA, but I can speak for Placer County and say, ‘Yeah, we don’t have any vaccine in our freezer,’ ” he said. “In talking to my colleagues, it sounds like most other counties don’t either. So I have to believe there is some sort of breakdown.”

Health officials across the region said the problem is too few vaccine doses. Some expressed confusion about reports — based on the error-filled and outdated official state reports — that there are millions of vaccines shipped to counties not yet administered into patients’ arms

“We are running out,” Jenny Tan, a Yolo County spokeswoman, said Wednesday.

“All the health officers in the Sacramento region have been using up their allocation, on a weekly basis,” said Brenda Bongiorno with Sacramento County.

Hundreds of El Dorado County residents are unable to make an appointment because none are available, El Dorado County spokeswoman Carla Hass said Wednesday. The county does not make appointments until it has vaccines to fulfill them.

“We just need more vaccine to meet the demand,” Hass said. “Our supply is running short. All the doses we currently have on hand are committed to appointment slots that have been filled.”

The situation is equally frustrating this week inside Sacramento-area hospitals.

Dr. Namrita Gogia, vice chair for internal medicine at Dignity Health, personally shared the frustration of county officials and the public. She agreed that some of the things that are being done now, like trying to reconfigure vaccine plans or hire enough workers to give shots, should have been done months ago.

“You know why? Because I really feel like it was a role that would have been nice if it was thought out with Operation Warp Speed,” Gogia said, referencing the federal government’s vaccine production effort. “Not just getting the vaccine out and then letting the states figure it out when they’re already taxed with testing, contact tracing, in the middle of a pandemic, fighting all these battles through budget cuts, through people threatening their lives and all of that.”

UC Davis Medical Center workers were getting vaccines in arms as soon as shots arrived, said Charles Casey, a spokesman. The hospital hoped to exhaust this week’s supply of 8,000 doses in the coming days. But, Casey said, the health care system had the capacity to double or triple the rate if it had the proper supply.

As of midday Thursday, he said it was unclear whether the medical center would receive another shipment next week.

“If we had additional vaccine supply, or knew for sure what vaccine supplies we could expect, we would be able to set up additional locations and vaccinate more people,” Casey said. “As eager as people are to receive a vaccination, we are just as eager to deliver it.”

Casey said the vaccine is already yielding results. Since vaccinations began a month ago among workers, the number of employees diagnosed with COVID-19 is down roughly 80%.

“This,” Casey said, “is a race between the vaccine and the virus.”

This story was originally published January 22, 2021 at 5:00 AM with the headline "State errors confound vaccine rollout in California, as Sacramento pleads for more doses."