California aims to vaccinate up to 3 million people a week by March 1 — more than double its current rate — under a distribution contract with Blue Shield that took effect Monday. The goal was set even as counties continued to face frustrating supply problems.
The partnership with Blue Shield is meant to repair what has so far been a bumpy, chaotic vaccination rollout in California, highlighted in the Bay Area this week by one major immunization site opening while two others closed because of vaccine shortages.
The Oakland Coliseum opens Tuesday morning as the largest vaccination site in Alameda County. The state began taking appointments for the clinic Sunday at MyTurn.ca.gov — its online reservation platform. But across the bay, San Francisco public health officials said clinics at Moscone Center and City College of San Francisco would be shuttered for a week because the city had run out of vaccine. Similar closures have plagued vaccine sites in Southern California.
The auspicious opening and the disappointing closures are among the most obvious markers of the struggle to vaccinate people quickly and efficiently in California. Access to vaccine often has been fickle, and residents have expressed frustrated confusion over when and how they will be able to get their shots.
“It’s obviously confusing for people. It’s hard to tell what’s going on,” Dr. George Rutherford, an infectious disease expert with UCSF, said in an interview Monday. “But this is not about bad intentions. It’s not about anything but the vagaries of the supply system. All we can do is ask people to bear with us as the supply catches up with the demand.”
State officials have said that the collaboration with Blue Shield will streamline distribution, leaning on the expertise of one of California’s largest insurance providers. The 55-page contract states that Blue Shield cannot be paid more than $15 million for its participation, and it cannot profit off of its deal with the state. Details of the partnership were released Monday.
The state continues to be responsible for approving vaccine allocations to counties and certain large health care providers such as Kaiser Permanente, and determining how doses are divvied up. Blue Shield is tasked with developing a system for helping the state make those decisions and for managing distribution details.
Blue Shield’s distribution system must take into account not just how many people are served by counties and providers, but how quickly they are administering vaccines and how well they’re reaching disadvantaged communities.
The state and Blue Shield set a goal of building up capacity so California is able to vaccinate 3 million people a week by the end of this month and 4 million a week by the end of April. Whether they are able to administer that many shots depends on supply, which is not controlled by the state.
California currently vaccinates about 1.3 million people a week. The state had administered more than 6 million doses as of Monday, according to the state Department of Public Health.
Other goals relate to equal access to vaccinations. For 95% of the population, vaccines must be available within 30 minutes of travel time in urban areas and 60 minutes in rural areas, and there must be plans to vaccinate people who cannot leave their homes. The contract repeatedly references developing goals and metrics for getting vaccines to communities that have been most burdened by the coronavirus.
The Oakland Coliseum site, along with a similar operation at Cal State Los Angeles, are meant to resolve some of those equity issues. The Coliseum clinic is open to all Californians, not just residents of Alameda County, though they must meet current county vaccine eligibility to make an appointment. That group includes health care workers; anyone age 65 and older; and workers in education, emergency services, and food and agriculture industries.
Both sites will prioritize access for people who may have trouble getting vaccinated elsewhere, state and federal officials said. Equitable distribution of vaccines has been problematic. Latino and Black residents in particular are being vaccinated at much lower rates than white people, despite carrying a much heavier burden of illness.
“These sites have been set up to reach populations that generally have a harder time getting access to good medical care,” said Grady Joseph, assistant director of the Governor’s Office of Emergency Services, or Cal OES. “We are approaching both of these sites from a lens of equity. And making sure that individuals who historically have a tougher time accessing are at the front of the line.”
The Oakland Coliseum and Cal State Los Angeles sites were the first announced by the Biden administration this month as part of a plan to build 100 mass vaccination clinics across the country in the president’s first 100 days in office. The Oakland Coliseum site seeks to deliver 6,000 doses a day. Both sites are run by the Federal Emergency Management Agency and the state, through Cal OES.
Vaccine supplies for the Oakland site come directly from the federal government, not Alameda County’s allotment, and people do not have to be county residents to use the site. Other large vaccination clinics, including those in San Francisco that were temporarily shut down this week, rely on vaccine supply from county allotments, which have been notoriously inconsistent.
Mayor London Breed bemoaned the lack of vaccine supply on Twitter on Sunday, when she announced that the two San Francisco sites would be closed until at least the end of the week.
“I’m frustrated because we’ve shown that SF can administer shots as soon as they come in,” Breed wrote. “The only thing holding us back is a lack of supply, and I’m hoping that will change soon.”
Similarly, public health officials have had to pause vaccinations at several sites in Southern California, including Dodger Stadium last week. That site will reopen Tuesday, but only for people receiving their second doses, public health officials said. They said their ability to scale up the clinic is limited largely by vaccine supply.
“Our city has the tools, the infrastructure and the determination to vaccinate Angelenos swiftly and safely — we simply need more doses,” Los Angeles Mayor Eric Garcetti said in a statement Monday.
Rutherford said the supply issues are partly a holdover from the Trump administration, which overpromised how many doses would be made available to states. Vaccines arrived at about the promised levels for the first couple of weeks of the rollout in early December, then quickly fell short.
“Everybody is trying to do as good a job as we can, given all the circumstances,” Rutherford said.