Experts Grade California’s Vaccine Rollout
Friday: We asked experts to assign a letter grade to the state’s vaccine rollout. Here’s what they said.,
On Thursday morning, Gov. Gavin Newsom rolled up his T-shirt sleeve and got vaccinated, marking the start of what he has described as the final stretch of an epic race to inoculate as many Californians as possible against the coronavirus.
The governor, who is 53, was newly eligible under the state’s vaccine rules, which as of the start of the month, allow anyone 50 and older to be vaccinated. And on April 15, in conjunction with a flood of supply promised by the Biden administration, eligibility will expand even further, to anyone 16 and older.
“We have an enormous opportunity in the next six to eight weeks to run the 100-yard dash,” Mr. Newsom told reporters on Thursday during another news conference at a vaccination site, this time in Los Angeles. “We’re this close.”
But the triumphant pronouncements and dazzling raw numbers — more than 18 million shots have been given to almost a third of California’s population — gloss over a messier reality.
[Read about the political stakes of the vaccine rollout for the governor, who is facing a likely recall election.]
From almost the first day shots were administered in the state, Dec. 14, the vaccine rollout has been dogged by a certain amount of confusion: There have been abrupt rule changes. And an opaque, multimillion-dollar contract with the insurer Blue Shield of California to manage the state’s vaccine rollout prompted an outcry from local officials, some of whom have suggested Mr. Newsom’s fear of being recalled was driving his decision-making.
Ultimately, though, how much has all of that affected the state’s outcomes?
I wanted to simplify the conversation. So I reached out to a dozen epidemiology, public health and equity experts throughout California and outside the state, and asked them to grade the state’s vaccine rollout and explain why.
The average grade they gave? B-
Nearly every expert I reached by phone or email in the last couple of weeks acknowledged the monumental nature of the task. But they also said that, like a capable student with clear advantages, California has a lot of room for improvement.
“California gets a C from me, the same grade I would use for a student who is engaging but could be doing much better with more effort and better study strategies,” said Dr. Alicia Fernandez, a professor of medicine at the University of California, San Francisco, who specializes in Latino and immigrant health.
Andrew Noymer, a professor of population health and disease prevention at the University of California, Irvine, gave the state’s rollout a C, emphasizing that it was a “midterm, not a final.”
[Track the vaccine rollout state by state, and see who’s eligible.]
In many ways, he said California and other states had made the vaccination campaign overly complicated; more people in the United States are inoculated for the flu every year, he said, “without the Sturm und Drang that has accompanied the Covid vaccines.”
Dr. Christopher Longhurst, U.C. San Diego Health’s chief information officer, gave the rollout a B-, largely because successful partnerships between public health departments and health systems have been hampered by the extra bureaucracy built into the state’s deal with Blue Shield.
“The transition to a vaccine allocation process overseen by Blue Shield was unwelcomed by county leaders and health systems alike and continues to operate with very little transparency,” he said.
By far, though, the biggest concern was that California hasn’t come close to meeting its lofty equity goals, which Mr. Newsom has repeatedly described as “a North Star,” guiding the state’s work.
Early on in the vaccine campaign, experts debated whether California’s strict prioritization of vulnerable populations and workers meant sacrificing crucial speed.
Advocates, however, have said that both should be possible, especially in a state like California, where officials are well aware of the state’s health and economic divides.
“Equity and scale are possible for the wealthiest states in the nation,” said Jacqueline Martinez Garcel, chief executive of the Latino Community Foundation, who gave the state’s rollout a C+.
[See how the virus pummeled poorer communities in Los Angeles.]
As supply has increased, the conversation has shifted to focus on the best ways to ensure that a fair share of doses actually gets to residents of the hardest-hit communities, which are often, not coincidentally, among the hardest to reach — rather than being snapped up by wealthier, more tech savvy white Californians.
Dr. Kim Rhoads, a community engagement expert at the University of California, San Francisco, gave the rollout a C-, because even the state’s well-meaning equity efforts, like a loudly promoted move to direct 40 percent of new doses to ZIP codes considered most vulnerable, don’t address the nuanced concerns of Black and Latino Californians.
“Most things in health care and dare I say public health are geared toward the majority population,” she said. “They’re not intentionally designed to address the issues in Black and brown communities.”
For example, she said that the state’s approach — dropping a vaccination clinic in a poor ZIP code — left out Black Californians, who have a history of being displaced and dispersed across cities.
The state’s apparent preference for big contracts to manage the vaccine campaign is frustrating for Dr. Rhoads and colleagues with community organizations, who already have relationships with the people the state is trying so desperately to find.
“We don’t see this so-called hesitancy at our pop-up sites,” she said, referring to her work with Umoja Health, a group that has brought testing, resources and, more recently, vaccines to communities of color in Oakland during the pandemic. Dr. Rhoads said that’s because the sites not only eschew complicated online sign-up systems, but they also are staffed by people whom community members are more likely to know.
And community organizations are more nimble — the better to adapt to rapidly changing supply constraints or other shifting conditions.
“It’s about bringing assets to the table, rather than staying in our same frame,” she said.
Still, many of the experts granted that, just as things could be better, they could also be much worse.
In terms of the state’s share of the population that’s been fully vaccinated and other broad measures, California is “squarely in the middle of the group of 50 states and close to the national average,” said Dr. Lisa Cooper, director of the Johns Hopkins Center for Health Equity, who gave the state’s rollout a C.
Dr. Cooper added that California was “slightly better than average in the Black-white and Latino-white disparities among those vaccinated.”
She said she expected to see the state improve to a B, “provided they don’t get bogged down in technical challenges related to their appointment system and administrative issues related to working with a private contractor.”
Dr. Sandra R. Hernandez, president and chief executive of the California Health Care Foundation, gave the state kudos for getting rolling at what she described as a record pace.
“The biggest negative is structural,” said Dr. Hernandez, who gave the rollout a B+. “Our fragmented, underfunded public health system and data infrastructure make it hard for all of the key players to move in unison during a statewide emergency.”
Dr. Grace Lee, a member of the C.D.C.’s vaccine advisory committee and a pediatrician at Stanford University, said that the fact that California was even trying to prioritize equity warranted praise.
“California is one of the few states that early on considered equity as a metric, and I continue to support that,” she said.
She was the only expert to give California an A.
Here’s what else to know today
Compiled by Jonathan Wolfe
A 9-year-old boy was among those killed after a gunman opened fire at a Southern California real estate office on Wednesday. The authorities said the boy died in the arms of a woman, believed to be his mother, who was trying to protect him. [New York Times]
The tech elite and Silicon Valley investors want to recall San Francisco’s district attorney, Chesa Boudin. They claim his progressive politics, like ending cash bail, has led to a surge in violent crime. [Mother Jones]
The water content of California’s Sierra Nevada snowpack is well below normal as the wet season comes to an end, and the state’s reservoirs are only about half full. [Associated Press]
California is plugging giant batteries into its power grid to try to avoid blackouts this summer. [Bloomberg]
Laura Wasser, one of Hollywood’s premier divorce lawyers, is representing Kim Kardashian West in her split from Kanye West. She spoke to The Times about managing the breakups of some of the industry’s most well-known A-listers. [New York Times]
As most teams look for ways to scale back, the Los Angeles Dodgers want to get bigger and better. But to do so they will have to create a new generation of baseball fans that go beyond the white boomer demographic that typifies the sport’s core audience. [New York Times]
Headed to the Oakland Coliseum for an A’s game? Here’s what you need to know about concessions, virus rules, seating and more. [San Francisco Chronicle]
And Finally …
Read this case for planting oak trees and then check out this list of California native oaks. Then, if you’re into it, think about trees for a bit. We hope you have some time to do that — or anything else that’s restful or regenerative for you — this weekend.
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Jill Cowan grew up in Orange County, graduated from U.C. Berkeley and has reported all over the state, including the Bay Area, Bakersfield and Los Angeles — but she always wants to see more. Follow along here or on Twitter.
California Today is edited by Julie Bloom, who grew up in Los Angeles and graduated from U.C. Berkeley.