Sacramento is falling behind in COVID vaccinations. How can the county get on track?
More than five months into the global effort to vaccinate against COVID-19, Sacramento County has consistently lagged behind neighbors in the region and California as a whole.
It’s a trend that remains disconcerting as the state plans to fully reopen its economy and drop most of its capacity and social distancing restrictions, as well as the mask mandate for the fully vaccinated, in less than three weeks.
Sacramento County’s rate for full vaccination, reported Tuesday at 37% of its 1.6 million residents, continues to rank last in the four-county capital region, according to data from the California Department of Public Health. Its rate for at least partial vaccination, at 47%, recently surpassed El Dorado County but still trails Placer and Yolo.
Among all Californians, 42% were fully vaccinated and 54% were at least partially vaccinated.
Breaking Sacramento’s numbers down further reveals broad discrepancies. The county was behind California’s average rate by a notable margin within nearly every demographic category tracked by the state, according to recent CDPH data for first doses in those 16 and older, who’ve been eligible since mid-April.
Across income levels and age ranges, Sacramento County trails statewide vaccination rates. Underserved neighborhoods, identified by the state’s Healthy Places Index, are also getting the vaccine at a lower rate compared to the state.
Although COVID-19 cases have begun a steady decline after weeks of plateauing, Sacramento public health officials remain alarmed by languishing vaccine demand as supply has grown to become sufficient and are scrambling to adjust their approach.
County officials acknowledge there are issues but say they are still working to craft appropriate responses to address them.
“If it were a single answer, then we would have a simple solution,” said Jamie White, the county’s epidemiology program manager, during a teleconference call with reporters last week. “It can be access issues. It can be hesitancy issues. It can be people feel there may not be an incentive.”
Sacramento’s comparatively poor numbers don’t appear to be simply a matter of undercounted reporting, which local health officers across the state had cited as a major issue earlier this year. Sacramento’s rates have trailed the state and neighbor counties like Placer and Yolo counties consistently, since the rollout began.
The county’s long plateau in case rate from February through mid-May also seems consistent with a county lagging behind California’s curve on vaccinations.
More recently, though, local infection numbers are finally starting to improve. Sacramento on Tuesday recorded its first week with a COVID-19 case rate low enough to receive credit toward the state’s “orange” tier level, meaning it could advance to looser restrictions next week if infections stay similarly low.
State data on Tuesday also showed Sacramento County hospitals were treating 73 confirmed virus patients — their fewest since June 2020.
Even so, with Placer and Merced advancing to orange earlier this week, Sacramento County finds itself one of the last eight among California’s 58 counties still in the more-restrictive red tier due to a case rate CDPH deems “substantial.”
The tier framework, along with most statewide COVID-19 restrictions except at large events with thousands in attendance, are all scheduled to end mid-June.
“We are still hoping that we’ll be able to make it (to the orange tier) before the June 15 deadline,” county health officer Dr. Olivia Kasirye said on last week’s call.
Kasirye said previously that even if Sacramento’s numbers are subpar in mid-June, the county is unlikely to impose tighter restrictions than California. While local health officers retain the power to do so after June 15, Kasirye said it would be difficult to enforce.
“I think at this point our main message is the vaccination, because that is our way of being able to get past this,” she said.
Who isn’t getting vaccinated?
Overall, rates for at least partial vaccination have been lowest among Black residents (36% in Sacramento County, 42% statewide); Latino residents (32%, 42%); and multiracial residents (17%, 27%), according to CDPH.
Kasirye said the county remains committed to addressing “variation” in vaccination rates between wealthy and poor communities, as well as in Black and Latino populations that have historically faced systemic health inequities.
But recent CDPH data also indicates that while higher percentages of white and Asian residents have been immunized than other demographics in Sacramento, the local vaccination rates in those populations have also trailed the California average by significant margins.
The percentage of white Sacramento County residents 16 and older with at least one dose trailed California’s rate in the same demographic by 12 percentage points (50% countywide vs. 62% statewide), and Asian residents trailed about 11 points (72% vs. 83%). Those two groups combine for roughly 60% of Sacramento County’s adult population.
‘All they needed was access through a human’
White and other county health officials repeatedly referred to Sacramento County’s vaccine issue as “multifactorial,” meaning a multipronged response is necessary to address it.
County and state health officials both recently acknowledged it will be key to shift away from large-scale vaccination sites, many of which were bustling earlier in 2021 when supply was scarce but have since seen throughput die down considerably.
“If toilet paper in 2020 taught us anything, it’s that people want things when it’s a rare resource,” White said.
County officials said the Cal Expo mass drive-through site, administration of which was transitioned last month to a partner called Curative Inc., would remain open but scale down its operations. A similar site at McClellan Park, also run by Curative, will transition to a smaller indoor, walk-in site with weekend and evening hours.
Those two clinics saw a sudden and dramatic drop in demand just a couple of weeks after the general 16-and-older population became eligible for the vaccine. On May 3, the county started accepting drop-ins at Cal Expo and McClellan Park and blasted out messages for residents to come get doses.
They were caught by surprise at the start of that week, with fewer than 100 of 3,500 appointment slots filled as of that Monday morning. County spokeswoman Janna Haynes at the time called it an “unprecedented” drop-off.
Emphasis quickly started to shift toward smaller, more community-led efforts. The next day, May 4, Gov. Gavin Newsom’s office announced the state would dedicate an additional $33 million to community-based organizations that help vaccinate, combat vaccine hesitancy or otherwise assist the campaign.
Local efforts to target outreach have centered on expanding and increasing the frequency of pop-up clinics at places like community centers and places of worship — settings Kasirye says “trusted messengers” can help bolster public confidence in and uptake of the vaccine.
The county is now urging local businesses and religious centers interested in hosting a local pop-up vaccine clinic — for employees, families, customers, congregations — to reach out to public health officials.
“We’re going with the mantra that every single vaccine counts,” White, the county epidemiology manager, told The Sacramento Bee in an interview. “So, you know, if we have a pop-up site with 20 or 30 people, we consider that a success.”
State numbers show that an average of about 3,600 Sacramento County residents per day received their first dose of a COVID-19 vaccine during the first two weeks of May. That total includes shots given at pharmacies and by local hospital networks in addition to clinics partnered with the county. Kasirye has said the county health office is partnered with more than 90 different organizations.
Last Friday at the Sam & Bonnie Pannell Community Center in Meadowview — a weekly clinic site — City Councilmember Mai Vang, Kasirye and other local leaders announced a new coalition with the goal of boosting vaccinations in south Sacramento neighborhoods.
Dr. Tecoy Porter, senior pastor of Genesis Church, had a clear and direct message: “Vaccinations are safe. They are not just a way, but the way, to get out of this pandemic.”
NAACP Greater Sacramento president Betty Williams said it is critical to recognize the digital divide in south Sacramento, which throughout the pandemic has had some of the highest COVID-19 transmission rates but also low vaccine rates.
The local NAACP chapter set up a phone line intended for those who either do not have access to broadband or aren’t comfortable setting up appointments using the internet, Williams said.
“The calls that we received were so horrendous. The fact that individuals thought that people did not want the vaccine was ludicrous to me,” Williams said Friday. “And so, all they needed was access through a human that had a telephone number that could make the appointments for them.”
The coalition, called Sacramento Alliance for Vaccine Equity, says it is dedicated to reducing language, cultural, digital and other barriers to vaccine access and uptake in south Sacramento.
Kasirye has also referenced geographic barriers.
“For some it’s transportation,” she said last week. “For some they will just not leave their neighborhood for one reason or another.”
The county recently deployed two new trailers to use for mobile clinics.
Kasirye acknowledged that some hesitancy comes as a result of misinformation including “online conspiracy theories” about COVID-19 vaccines, which clinical trials and real-world data have shown to be safe and highly effective. Public information campaigns and trusted messengers will be important to combat misinformation and misconceptions, she said.
Vang, whose city council district includes Meadowview, spoke of the need to reframe vaccine hesitancy instead as “vaccine readiness.”
Beer, ballgames and ice cream?
For as complicated of a concept as it is to boost vaccination rates to ease the burden of a devastating pandemic, there are two very simple incentives: fun and freebies.
The county probably won’t come up with anything as grandiose as Ohio’s million-dollar lotto for the vaccinated, but Kasirye suggested “fun events” as simple as the promise of free ice cream could help encourage more people.
Or what about a ballgame?
Across the river in West Sacramento, the minor-league River Cats offered vaccines at their May 20 home-opener — and gave free beer or a hot dog to those who get their jab at Sutter Health Park. River Cats media coordinator Conner Penfold told The Bee about 40 fans made use of the promotion. By White’s standard, that’s a success.
Republic FC and Sacramento County announced this week they will partner to hold vaccination clinics at the soccer team’s next three matches at Heart Health Park, offering hundreds of free tickets to fans who make use of them. Those who get a first dose this coming Saturday can get their second dose at another match four weeks later, on June 26.
“We are exploring all different ideas and looking at what other counties have done,” Kasirye said last week. “We have not narrowed down which ones we will start with, but definitely looking for ideas for that.”
Long road to 70%, possible herd immunity
Early vaccine momentum has died off. It peaked a while ago.
State health data show Sacramento County’s pace for new vaccine recipients hit its highest point nearly a month before the state expanded access to 16 and older in mid-April. The weekly average topped out at about 8,600 daily first doses for the week ending March 18, according to CDPH numbers.
That rate slowed to about 3,000 a day for the week ending May 13, though it has rebounded some since that date, when the state opened up eligibility for adolescents 12 to 15.
If Sacramento’s pace for new first doses doesn’t pick back up, it could easily take all summer and possibly well into fall to reach a vaccination rate of 70%, which some health experts have pointed to as the bare-minimum estimate for possible herd-immunity status. As of now, getting to 70% would require roughly 360,000 additional county residents getting vaccinated.
There are a few bigger-picture developments that should help boost demand down the line.
One is the eventual authorization of existing vaccines for children younger than 12.
Another could be full approval from the Food and Drug Administration, rather than the current emergency use authorizations, of any of Pfizer, Moderna or Johnson & Johnson’s COVID-19 vaccines.
Full FDA approval could help convince those on the fence about getting the vaccine, and it will also trigger COVID-19 vaccination becoming mandatory at California State University and University of California campuses, affecting Sacramento State and UC Davis students and employees in the region.
It’s important to note that the mass drive-thru sites and county-supported pop-up sites at community centers are just a couple of the many ways residents can get shots.
Health networks including Kaiser Permanente, Sutter Health, UC Davis Health and Dignity Health’s Mercy Medical Group all offer appointments to existing patients in the Sacramento area. UC Davis Health and Kaiser Permanente have also for weeks been holding clinics that are open to non-patients.
And nationwide, many major pharmacy chains including Rite Aid and CVS now offer walk-in appointments at all or most locations, with doses supplied through a federal partnership.
It has never been easier to secure an appointment.
This story was originally published May 27, 2021 at 5:00 AM.
