Editorial: We need a real shot in the arm

Friday, Jan. 27, marks seven weeks since the Food and Drug Administration authorized the first COVID-19 vaccine in the United States. The Pfizer-BioNTech vaccine, followed by another from Moderna, made its way to local health care workers and long-term care facilities starting in December.

Those who have received the vaccine are among the lucky few, as California ranks in the bottom half of states in percentage of vaccine doses administered. In San Mateo County, 58,750 doses had been administered to 48,826 people as of Jan. 25 or 6.3% of the population, according to a newly released data dashboard. Santa Clara County as of Jan. 26 had given out 169,776 first and second doses; the countywide population is estimated to be 1.9 million.

A lack of supply is the chief barrier to more widespread vaccination, according to health officials. The Trump administration reportedly did little planning with its “Operation Warp Speed” rollout, and health officials learned earlier this month that second vaccine doses that they thought were being held in reserve by the federal government had in fact already been distributed. To this day, counties and medical providers still don’t know when they will receive vaccines or the amount they’ll receive in a timely manner, which inhibits planning. As San Mateo County Health Officer Dr. Scott Morrow said in a statement Jan. 19, “We all want to go faster, but until this supply issue is ameliorated, we won’t be able to.”

Some have also pointed to the state’s tiered vaccination plan as something that, while intended to ensure equity, has slowed the rollout.

“In a well-meaning effort to achieve equity, we are creating systems so complex and messy that they can thwart the goal of equity. Simpler is better,” Dr. Robert Wachter, chair of the department of medicine at University of California at San Francisco, recently told CalMatters.

This week, federal and state officials took steps to address these concerns. President Joe Biden announced that his administration is working to purchase an additional 200 million doses of the COVID-19 vaccines, which would increase the total vaccine order for the country by 50%. And on Jan. 25, Gov. Gavin Newsom announced that the state will change its vaccine distribution hierarchy to an age-based system once all health care workers, people over age 65, food and agriculture workers, teachers and school staff members are vaccinated. Doing so “will allow us to scale up much more quickly and get vaccines to impacted communities much more expeditiously,” Newsom said.

“We realize we have got to increase throughput here,” he said. “While we are proud of the framework we put out … we recognize it has advantages and it has disadvantages as it relates to speed and efficiency.”

While talk of ramped-up vaccine distribution is encouraging, it will still take months to get a large swath of the population vaccinated. As millions wait, they shouldn’t be left in the dark by lack of clear information.

But that’s just what’s happened so far. When state officials announced earlier this month that they were opening COVID vaccine appointments to all residents 65 and older, people called and emailed their health care providers in droves, waiting on hold for hours and combing through websites in search of an answer and a vaccination appointment. Some took to social media, seeking information by messaging county health Twitter accounts or just an opportunity to vent.

“The level of confusion Californians are getting left with in this process is absurd,” Twitter user Rob Lion wrote in response to a tweet from San Mateo County Health on Jan. 14, one of several replies from exasperated residents.

What wasn’t immediately clear was that the state’s new guidelines would be up to the counties and health care providers to implement. Santa Clara County decided to offer vaccines to those 75 and older (and on Wednesday widened eligibility to those 65 and older), while San Mateo County in recent days began vaccinating priority residents over 65 who receive medical care through its clinics.

“The balkanization of the distribution of the vaccine has contributed greatly to the consternation and chaos the general public feels,” Dr. John Swartzberg, an infectious disease specialist at University of California at Berkeley, told CalMatters. “What county you’re in will determine what age group is getting the vaccine … What health system you’re in will determine if you can get the vaccine. The questions just go on and on.”

Compounding the confusion, San Mateo County announced on its website Jan. 17 that it was transitioning to the next vaccination phase, which would include residents 65 and older, but it wasn’t clear to our journalists until a call to the county Jan. 19 that the county did not yet have sufficient doses to actually do so.

While we certainly appreciate the difficult task facing San Mateo County health officials, we do see room for improvement in their communication about vaccine availability and COVID-19 in general.

The county has rolled out an interim website where residents can sign up to receive COVID vaccine-related updates, including on vaccine eligibility. We stumbled across it (find the link at smchealth.org/covidvaccine) while perusing the county’s vaccination program webpage; if there has been any promotion of this sign-up page, it appears to be scant. While the state is piloting a similar sign-up site in Southern California that it plans to launch statewide in the coming weeks something that should have been ready when vaccinations began we think county residents would appreciate knowing about the local option.

San Mateo County also could adopt some strategies from its neighbors in Santa Clara County. Santa Clara County’s public health department regularly posts the latest data on COVID-19 cases, with links to its data dashboard, on social media. It regularly livestreams press conferences and relevant Board of Supervisors items, making them accessible to someone scrolling through Twitter or other social media sites; San Mateo County recently livestreamed an information session on Twitter, but it does not typically promote County Manager Mike Callagy’s weekly media briefings or health officials’ COVID-19 updates to the Board of Supervisors on social media, nor does it post the latest information on case trends. San Mateo County officials regularly post pandemic-related health and wellness tips, which are definitely useful, but putting out more information about the question on the minds of many when can I get vaccinated? could help ease some of the anxiety.

Health care providers and government officials should make targeted efforts to reach out to our most vulnerable populations through other means so that those getting the vaccine aren’t just the people who are most tech-savvy.

Voice editorial board, Jan. 29 editorial

But state and local officials, in relying heavily on tech-dependent tools to get vaccination information in the hands of its most vulnerable residents, have underscored the existing technology divide. It’s not just students doing distance learning who are struggling. There are an untold number of senior, relatively rural and low-income households throughout the Midpeninsula that don’t have reliable internet or computer access or don’t own smartphones, or who may struggle to use the technology even if they have access to it.

Some medical providers, like Kaiser Permanente, have indicated they will contact patients directly when they’re eligible for the vaccine, but what about those who can’t easily access the internet or a smartphone and are told to sign up online for vaccination appointments? Or to even find out when they’re eligible, they must rely on someone else to help them? Health care providers and government officials should make targeted efforts to reach out to our most vulnerable populations through other means so that those getting the vaccine aren’t just the people who are most tech-savvy.

In his statement earlier this month, Morrow addressed peoples’ inherent dislike for uncertainty and ambiguity, acknowledging that they “create anxiety” while also positing that “uncertainty and ambiguity are always going to accompany the implementation of an endeavor at this scale, especially in the early phases.”

The vaccine rollout has certainly been wrought with uncertainty and ambiguity, and we do understand that this is an unprecedented moment and how much this pandemic is straining our resources. But better communication from government and health care officials and medical providers in the meantime will help dispel false information about the vaccines, improve equity and access, and bring some comfort to those anxious for accurate, clear information.