After receiving even fewer than normal vaccine doses from the state this week, San Mateo County will be shifting its COVID-19 vaccination strategy.
County Manager Mike Callagy announced at a press briefing on Wednesday that the county would move away from operating mass vaccination sites, instead funneling its limited doses to six or seven community vaccination clinics, including one on the Coastside.
“We’re going to be taking a door by door, block by block approach to areas we’ve seen have been COVID hotspots,” Callagy said.
The change is motivated by stunted vaccine supply. This week, the county received just 18,700 doses, down from around 22,000 in prior weeks, Callagy said. He is not expecting an increase in the coming weeks. Most of this week’s doses will go to residents on track to receive their second dose. The low supply is due to a new state policy that allocates 40 percent of California’s supply to the most vulnerable census tracts, none of which are located in San Mateo County.
Callagy did not specify exactly which cities or neighborhoods would receive doses in the coming weeks, but indicated clinics in neighborhoods like East Palo Alto that have been hardest hit by the disease, in addition to those with the lowest rates of attendance at mass vaccination sites, will be prioritized.
“We’re not waiting for the state to increase our doses to underserved communities,” Callagy said. “We’re doing it ourselves.”
The county is switching strategies to focus on prioritizing vulnerable communities and to make scaling up simpler when the supply flow eventually improves, Callagy said. Also a factor is retaining vendors like Carbon Health that could find larger contracts elsewhere.
The announcement comes as the county is in negotiations with the state over its contract with Blue Shield of California, the company now tasked with taking over state vaccine allocation and distribution. Callagy said the county is obligated to work with Blue Shield, but is negotiating a memorandum of understanding with the state to ensure that the county retains a role in deciding local vaccine allocation. Plus, he said the county hopes to be consulted for its knowledge and connections to community organizations.
“We’ve vaccinated about a third of county residents through this mechanism with our partners,” Callagy said. “Our greatest concern is that we don't want that interrupted in any way.”
Part of the motivation for an MOU with the state, Callagy said, is to maintain equitable access to the vaccine. Around 27 percent of adults living in the county’s most vulnerable census tracts have gotten vaccinated, as opposed to the 33 percent of county adults vaccinated overall.
Callagy said that disparity is in part due to who has been eligible so far. Some of the lowest-income neighborhoods like East Palo Alto might skew disproportionately younger, while other lower-risk areas might have more residents who are health care workers or people who are 65 and older.
County Health Deputy Chief Srija Srinivasan said uptake of the vaccine in each high-risk area can differ widely depending on the strength of local community organizers and trust in the vaccine.
“Each week, we're trying different ways to build that confidence,” Srinivasan said.
Although the county tracks the percentage of residents in each city who have gotten vaccinated, those numbers aren’t accurate. Pescadero, for example, is reporting 100 percent of residents vaccinated. But that’s based on old census data, which claims that just 219 people live within the town’s borders. Callagy said the county is basing its outreach strategy less on data and more on evidence from existing vaccination events happening on the ground, which paint a more accurate picture of the volume of vaccines needed.
County doses aren’t the only ones flowing into locals’ arms. Local pharmacies like Rite Aid and CVS are getting doses from the federal government, and health care providers like Sutter Health, Kaiser Permanente and Dignity Health have their own supply. But county data shows the county has been handling around 60 percent of the total incoming doses, while large health care providers have received and distributed just under 30 percent. The federal government has supplied just 10 percent of doses going into residents’ arms to date.
This week, vaccine eligibility expanded to those of any age with conditions that make them more at risk of serious adverse effects to COVID-19, including those with cancer, severe obesity, heart conditions or other conditions that compromise the immune system. The county is also now taking mobile clinics and its street medicine team to homeless shelters to vaccinate unhoused locals. Plus, inmates who were not already considered eligible now have the green light from the state to receive vaccines. Srinivasan said the county is targeting inmates due to be released soon and will begin getting shots in arms at local jails this week.
In addition to low vaccine numbers, still plauguing the county’s efforts is the unpredictability of the coming doses. But Callagy said even without mass vaccination sites, no dose will go unused.
Still, the county is aiming to get everyone who wants a vaccine access to one by the end of May, in line with President Biden’s national goal, Callagy said. But he said it will only be possible if the county begins to get more vaccine doses.
“If we get the doses necessary, we can scale very quickly,” Callagy said. “... We are in a race against time.”