California’s COVID vaccine schedule keeps changing. Here’s why
It took a lot of discussion, but in December, California came up with a multi-tiered, multi-phase plan on how the state would vaccinate its residents against the coronavirus.
First would be healthcare workers, followed by teachers, farmworkers, emergency responders and people 75 years and older. In the subsequent phases, people’s jobs, medical conditions, disabilities and living situations would all be factors in deciding whether someone got a vaccine ahead of others.
That plan, however, is far from what the state has now.
Dealing both with the scarcity of vaccines and delays in giving doses it does have, California changed its vaccine prioritization framework at least three times in little over a month, including one switch that went virtually unnoticed. A key state panel has just proposed a fourth change to the framework.
One’s age is now the key factor in deciding who gets the vaccine ahead of others, while those who are homeless, incarcerated are no longer being prioritized. Neither is a list of other essential workers, including transit workers, factory and warehouse workers and janitors.
The framework is “a living document,” given how the virus is evolving, said Dr. Jeff Goad, chair of the Department of Pharmacy Practice at Chapman University and a member of the state work group helping officials develop the framework.
The changes frustrate some advocates and local health officials, who say the sudden and unexpected shifts make it impossible for them to plan and dash hopes among the public.
“It feels like a whiplash,” said Andy Imparato of Disability Rights California. “It’s a roller coaster, where people’s lives are at stake.”
Changing vaccine priority
California officials in December proposed a four-phase system: Healthcare workers would be in the first phase. Those working in education, emergency services or food and agriculture would be in the next phase, deemed Phase 1B Tier 1, along with those 75 and older.
Those working in manufacturing, transportation and logistics or facilities and services would be in what the state deemed Phase 1B Tier 2, along with those who are homeless, incarcerated or aged 65 to 74 with chronic conditions.
Those in industries such as communications, defense, finance and energy would be in Phase 1C, along with those aged 65 to 74 without chronic conditions and those aged 16 to 64 with chronic conditions. The rest of Californians would be in the last phase.
“California is determining its distribution guidelines in an open and equitable fashion as initial vaccine supplies will be very limited,” Gov. Gavin Newsom’s office said in a December press release.
The state, however, began changing the system just a couple of weeks in.
In early January, the state moved those aged 65 to 74 without chronic conditions into Phase 1B. All of those aged 50 to 64 moved into Phase 1C.
A few days afterward, state officials moved everyone 65 and over to the front of the line right after healthcare workers, after delays in vaccine administration prompted federal health officials to change their guidelines and urged states to do the same.
“There is no higher priority than efficiently and equitably distributing these vaccines as quickly as possible to those who face the gravest consequences,” Newsom said on Jan. 13.
On Jan. 25, Newsom announced the state would shift its vaccine strategy to an “age-based approach,” meaning that after vaccinating those 65 and over as well as some essential workers such as teachers and farmworkers, the state would distribute vaccines based on age rather than occupation, health status or crowded living conditions.
The strategy “will allow use to scale up much more quickly to get vaccines to impacted communities much more expeditiously,” Newsom said then.
The state is now looking at making fourth change to its framework, by putting those with a disability or medical condition regardless of age next in line after those 65 and older and some essential workers. It’s unclear when or if that change will be made.
State officials have said several factors explain the shifts. One was a concern that the state’s multi-tier, multi-phase approach had complicated the vaccine rollout that once had the state ranked at the bottom of doses administered.
Another factor is that the state has gotten much less vaccine than it had anticipated, which meant some groups had to be left out. In December, California anticipated giving first doses to 6.25 million people by the end of January. As of Feb. 5, only three million people in the state have their first doses of the vaccine, according to data from the Centers for Disease Control and Prevention.
Goad also said the state’s December and January surge in COVID-19 cases, with intensive care units at capacity, meant his group needed to think about how to free up hospital beds. That meant prioritizing vaccination for older residents, who are most likely to be hospitalized.
“The work group was very persuaded by the data to keep people from dying of COVID,” he said.
California is far from being the only state that has shifted its vaccine priority. From Pennsylvania to North Carolina to Montana, many states changed their strategy to prioritize vaccinating older residents.
Local health officials scramble
California did not move teachers, farmworkers and emergency responders lower on the list when it added those 65 and older. Teachers, in particular, have demanded they be vaccinated before resuming in-person instruction, and Newsom has emphasized that he wants schools to reopen quickly.
That meant another 3.5 million people were told they were eligible for a vaccine without an increase in supply.
In a press release on Jan. 19, Yolo County Public Health Officer Dr. Aimee Sisson said the state’s shift to vaccinating everyone over 65 was “creating unreasonable expectations among the public.”
“When everybody is a priority, nobody is a priority,” she said.
The revisions have come suddenly, not giving counties enough time to adapt, said Jenny Tan, spokeswoman for Yolo County.
On Tuesday evenings, the state tells Yolo County how many doses it’s getting for the following week, Tan said. That means the county has just a week to plan for how to give out those doses, from figuring out where to have clinics to providing outreach to residents, she said.
When the state announced its shift to vaccinating everyone over 65, Yolo County simply didn’t have enough vaccine to do so, Tan said. The county stuck to vaccinating those over 75 until just a few days ago, although that didn’t prevent people over 65 from flooding the county’s phone line asking for doses.
“We’re planning things out in a very tight and strategic manner,” Tan said. The state’s shifting approach “adds another level of complexity to already a short timeline.”
Meanwhile, the state’s decision to no longer prioritize those with disabilities drew outrage.
Despite the state’s recent proposal to put those with a disability or medical condition next in line after older residents and some essential workers, the disabled community is still confused as to what that means, Imparato said.
“We don’t really know where we are,” he said, adding he hopes he’ll get more details soon.
Some groups representing essential workers left out by the move to an age-based system are also urging Newsom and state officials to reconsider.
On Feb. 2, transit agencies in Los Angeles and Orange counties sent a letter to Newsom, urging him to again prioritize transportation workers for vaccination.
Many transit workers are providing rides for people to get vaccinated, said Michael Pimentel, the executive director at the California Transit Association. He argues that adding an estimated 35,000 workers wouldn’t slow down vaccine delivery.
“There’s a capacity to still honor the role of transportation workers in supporting other workers that doesn’t affect the state’s ability to accelerate vaccination,” he said.
Defining a successful vaccine rollout is difficult, said Steve Maviglio, a Sacramento Democratic political strategist.
Speed is one measure; on Friday, Bloomberg data showed California as the 10th slowest state when it comes to using its supply.
Making sure the process fairly includes everyone, including disadvantaged communities, is another. Equity is a factor California’s working group is trying to weigh.
Politics also plays a role, Maviglio said.
“As much as politicians like to say, everything is based on science, politics is always going to be a part of the equation,” he said.
In the end, consistency and clear messaging about the vaccine rollout may be the best politics, Maviglio said.
“Whether you’re a business or state, you want to stay consistent,” he said. “It’s difficult to do that when goal-posts keep moving.”
This story was originally published February 6, 2021 at 5:00 AM.
