Local health officials say they’re stuck wondering how the state allocates vaccines. They’ve tried to peel back the curtain on a mysterious state formula only to have their curious questions met with vague or nonexistent answers; reporters didn’t have any better luck. And the timing couldn’t be worse.
The public is clamoring for inoculations against the coronavirus while doses trickle in from the federal government to California — which must then distribute the vaccines down the line. It’s the last part of the equation that has so far stumped them.
Local governments, it seems, are at the mercy of the state.
That’s because California’s formula to distribute vaccines on a local level has remained an enigma, at least according to officials with Pasadena and Long Beach — two Los Angeles County cities that have their own health departments and are tasked with administering the doses on their own.
While officials for both cities say they believe vaccines have been distributed equitably to local health jurisdictions, based on their own reviews, they don’t know how, exactly, the state’s distribution formula works. That has left health officials frustrated, they said, with predicting how many doses they and their partners will receive a difficult task.
While that lack of clarity may not be fatal to local distribution plans, according to Pasadena and Long Beach officials, it does illustrate the challenges inherent in marshalling federal, state, local and private healthcare resources to inoculate millions of people as quickly as possible when there simply isn’t enough supply.
“I think we’re getting the proportion, or the share, that anybody else is getting in this limited time frame,” said Kelly Colopy, Long Beach’s Health and Human Services director. “But are we receiving enough? Well, nobody is.”
The secret formula
California has created tiers that prioritize who should get vaccinated when: Healthcare workers first, then those in other essential fields and folks at least 65 years old. Educators are relatively high on the list, while general distribution — for healthy adults who don’t work in an essential field — remain months from being eligible.
California distributes vaccines based partly on the population a jurisdiction has for a given tier, said a spokesperson for the state’s Department of Public Health.
“Vaccines are distributed to counties,” the spokesperson said, “based on population in a specific tier, the number (of vaccines a jurisdiction has) yet to deliver, and a series of other factors.”
The state, however, did not respond to follow-up emails asking for clarification and more details about its distribution plan, specifically around the “series of other factors.” Officials also did not reply when this newsgroup asked if the state could share the populations of each vaccine tier.
But even on the local level, those figures are difficult to calculate, said Dr. Matt Feaster, epidemiologist for the Pasadena Public Health Department. Feaster said he believes the city has about 13,000 healthcare workers eligible for vaccines in the first tier and about 22,000 seniors over the age of 65 who would be eligible in the second tier.
But there isn’t a central repository that has those figures, he said, and it took significant work to come up with estimates.
Long Beach, meanwhile, doesn’t have an exact count of its initial tiers, Colopy said, “because they are large definitions and we are vaccinating those that live and work in Long Beach.”
Is it unknown, then, how the state would calculate those numbers if local health departments are struggling to do so?
“That’s a good question,” said Dr. Ying-Ying Goh, Pasadena’s Public Health director and medical officer.
“In every call (with state officials),” Goh said, “local jurisdictions are asking what is the formula and they have not shared it.”
The state has, however, published “ballpark” estimates for how many people are in each tier statewide — but even those figures don’t have clear origins.
“I don’t know how they’re calculating it,” Goh said.
Still, after doing a review of each health jurisdiction’s vaccine allotments, Goh said she believes Pasadena got its fair share. Long Beach officials said they feel the same.
At least for now.
Pasadena, with a population of about 141,000, has received more than 26,000 vaccines since distribution started. Long Beach, with roughly 460,000 people in it, received more than 63,000 doses in the same period.
But a straight comparison of vaccines received, as a proportion of a health jurisdiction’s population, doesn’t work, for various reasons. Population figures, for one, don’t count those who work but don’t live in a given jurisdiction.
And those jurisdictions — cities, in this case — also don’t have a uniform number of employees in each industry.
Take Pasadena. It has more nursing-home and assisted-living beds per capita than any other health jurisdiction in LA County, including Long Beach, which has three times the number of residents.
Many of Pasadena’s healthcare workers are in its lone acute care facility, Huntington Hospital, which typically has about 500 beds in it. The rest of the workers are spread throughout the city’s 95 long-term care facilities where residents are also eligible for vaccination.
Long Beach, meanwhile, has three major acute care hospitals, each holding from 360 to 410 beds, plus two smaller hospitals, each with about 125 beds, according to state data. It has 71 long-term care facilities.
Still, Pasadena’s initial vaccine allocation included a “disproportionately high number of doses,” Goh said, “because we have a disproportionately high number of healthcare workers.”
It stands to reason, then, that Pasadena’s allotments could decline relative to Long Beach’s as they move through the tiers — if the latter has a larger number of workers in a given tier.
But it’s unclear when or if the state will alter its formula.
Long Beach, for example, began vaccinating those at least 65 years old in mid-January, and L.A. County began a few days later. Pasadena, meanwhile, only started inoculating that group this week.
But it’s not known if the state adjusted its formula specifically for Long Beach as it began vaccinating elders ahead of the other county health jurisdictions — or if the state lumps everyone together, like it does for ICU bed capacity under the current regional stay-at-home order.
It’s also unclear from publicly available data just how many people each jurisdiction has to inoculate.
One thing, however, is apparent to local health officials: the available number of vaccines is far from enough.
Supply too low
Long Beach and Pasadena have both distributed more than half of their allocations thus far, though Long Beach is slightly ahead; about 38,000 doses have been doled out in that city. Pasadena, meanwhile, has distributed about 14,000 or so.
But proportional distribution is not the biggest problem, Goh said.
“The primary issue is the number of doses arriving in the state,” Goh said. “There’s just too few of them.”
Making matters more complicated, the state may not always have an accurate picture of how many doses have been distributed, Goh said.
The state’s tracking system, which asks each distributor to report the shots they’ve given in the last 24 hours, “isn’t giving us adequate data to hold everyone accountable,” she said.
“The quality of that data is dependent on every provider,” Goh added, “but it seems like there’s a reporting gap.”
When she asks the state for more vaccines, Goh said, she’s had officials tell her there are doses sitting around in her jurisdiction.
“We don’t have a good idea about whether it’s sitting (around with a healthcare provider),” Goh said, “or if they’re not updating their registry.
“The tracking is murky on the state level right now,” she added, “so we’re just trying to do it on the ground” by calling each provider every week.
It could become more complicated in the future, as the city looks to set up primary care physicians as the main distribution centers for the vaccine, rather than the massive sites seen at Dodger Stadium and other parts of the county. Long Beach has also opened its Convention Center for vaccine distribution, with officials there saying it has the capacity to inoculate 3,000 people a day.
Pasadena Mayor Victor Gordo, meanwhile, has asked the state for permission to turn the Rose Bowl into a mass vaccination site, warning in a recent letter that it could take the city a year to inoculate everyone at its current pace.
But accurate reporting and having the capacity to vaccinate thousands of people a day are still lower priority concerns. The paramount concern remains unchanged since the vaccines hit the market: Having enough supply.
“That’s kind of the problem we’re running up against now,” said Greg Geisler, a private practice cardiologist with admitting privileges at Huntington Hospital. “There’s only so much vaccine coming from the state, and we have to make sure those that got their first shot are getting their second shot. Then we can use the next allocation to bring in more patients.”
This situation prompted Pasadena Mayor Victor Gordo to ask the state for more vaccine doses.
In Long Beach, Mayor Robert Garcia has touted the city’s approach of using every vaccine it receives.
“We didn’t, I think, overly plan how many vaccines are we going to do this week and next week until we run out,” Garcia said in a virtual discussion with Gov. Gavin Newsom this week. “We said, ‘How many vaccines are we going to do today? How many vaccines do we get out as quickly as we can today and tomorrow?’, and I think that’s something that I think a lot of health jurisdictions should also be thinking about.”
Newsom praised Garcia’s approach, saying the “scarcity mindset” in other jurisdictions has prevented them from vaccinating people as quickly as Long Beach.
“It’s really important to learn from your experience,” the governor said, “and your example.”
Garcia, meanwhile, noted that even though Long Beach’s strategy means it runs out of vaccines quicker than other cities or counties, that’s “a good problem to have.
“As long as we are prepared and planning for the second dose regimen, which is really, really critical in the days ahead,” the mayor said, “running out of vaccine — as long as you can take care of the second-dose folks — is not a bad problem to have. That’s a good problem. That means we’re doing our job and getting the vaccine out to people.”
Both Garcia and Newsom said plans from the new presidential administration will provide more clarity on vaccine supply for the state and for local jurisdictions.
But even with more transparency from the federal government, the state’s method for allocating doses remains unclear.
Cities and counties can use up every dose they receive, but then they’ll be left waiting for a mysterious formula to deliver more.
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