Humboldt in the Middle

County vaccination administration rate ranks 28th of state's 58 counties as state revamps system


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With so many believing the little glass vials of COVID-19 vaccine are the ticket to a post-pandemic life, people are understandably anxious for their turn to get the shot and, in some cases, frustrated the process isn't moving more quickly.

It's also easy to watch news reports of large drive-through vaccination clinics in urban areas of the state and country and to wonder, is little Humboldt County being left behind? Is the local Public Health department getting proportionately as many doses as other areas and are those making their way into residents' arms as quickly?

The county's Joint Information Center included vaccination data into its COVID-19 dashboard last week, indicating that 26,789 doses have been administered locally, with 8.86 percent of the local population now partially vaccinated and 5.42 percent of locals having received both doses and designated as fully vaccinated. But those numbers need some context to really understand how Humboldt County is faring comparatively.

On the eve of revamping its approach, the state launched a vaccination dashboard last week, showing that it has delivered 10.1 million doses of vaccine to counties and that 8.2 million of those have been administered. The dashboard then breaks down the administered doses by county, so you can see how many shots have been given in every county from Imperial to Del Norte.

Unsurprisingly, the state's most populous county — Los Angeles — leads the charge, having administered nearly 2 million vaccination doses, while its smallest county — Alpine — brings up the rear with 453 shots given. However, adjusting for population — or looking at doses administered per county resident — gives perhaps a clearer picture of how each county is faring in the race to vaccinate its residents.

By this metric, Humboldt County ranks just about in the dead middle of the state — 28th out of 58 counties — having administered the equivalent of .209 doses per resident. Little Mono County, meanwhile, has proportionately administered the most doses, having given the equivalent of .543 doses per each of its 14,310 residents, while Kings County appears to be having the most trouble getting shots in arms, having administered .083 doses per each of its 150,691 residents.

Mendocino County appears to be faring the best of Humboldt's neighbors, having given .297 doses per resident, outpacing Trinity County's .135 doses and Del Norte County's .119, which is one of the state's lowest.

While the state has repeatedly stressed equity as a guiding principle in vaccine allocation, there appears to be an economic divide. By the Journal's analyses, the state's five richest counties by per-capita income — Santa Clara, San Mateo, Marin, San Francisco and Contra Costa — averaged .255 doses administered per resident, notably better than the statewide average of .208. Meanwhile, the state's poorest counties — Imperial, Madera, Tulare, Merced and Kings — averaged .129 shots given per resident, indicating their residents are getting vaccinated at half the rate of their wealthier counterparts.

Now, there's a lot this metric doesn't account for. All counties are at the mercy of the state, which is in turn at the mercy of the federal government, for how many doses they receive. The state has said it is allocating doses based on population but it appears other factors are also considered (as Mono County's rate would suggest). And the metric only accounts for doses administered, so wouldn't differentiate a county with an unused stockpile in the freezer and one putting those shots into arms as soon as they are delivered by the state.

There's also reason to question the accuracy of the date itself. It lists Humboldt County as having administered 28,393 doses — 1,604 more than the county's dashboard indicates have been given. And Del Norte Health Officer Warren Rehwaldt penned a lengthy letter to the Del Norte Triplicate this week detailing a host of frustrations with the vaccine rollout, including discrepancies between state and local data on the number of vaccinations on hand and administered.

But by far the biggest limiting factor in getting people vaccinated remains supply. Humboldt County Public Health announced last week that it has been allocated 4,740 vaccine doses for the coming week. While those doses will be split between first and second doses, they're enough to fully vaccinate 2,370 people. Unless that allocation rate increases substantially, it would take most of the year to fully vaccinate the county's adult population.

County health officials reminded in a press release last week that the U.S. Centers for Disease Control and Prevention has reported that the Moderna and Pfizer vaccines approved for emergency use have undergone "the most intense and comprehensive" safety monitoring in U.S. history. While mild side effects — like soreness at the injection site, fatigue, fever, body aches — have been reportedly locally, most commonly after people receive their second dose, serious adverse reactions have not. Trials showed both vaccines to be more than 94 percent effective at preventing COVID-19 illness.

Currently, the county is vaccinating residents over the age of 70, healthcare workers, teachers and first responders, with food and agricultural workers next up. In a media availability last week, Health Officer Ian Hoffman made clear the speed of the process will depend on supply

"It will depend entirely on the amount of vaccine we have," he said, adding that he's hopeful approval of Johnson and Johnson's vaccine will add to allocations in the coming weeks. "We also know that the federal government has continued to promise to send more. It looks like that is actually starting to happen in the next few weeks, so when we have enough vaccine, we'll open up to more tiers."

Looming in the background of all this was the state's announcement last month that it is revamping its vaccine delivery framework, reconsidering eligibility guidelines, creating a statewide registry and notification system [ or (833) 422-4255] and instituting sweeping changes that would put it in more direct control of vaccine distribution and administration across all 58 counties.

Specifically, the state intends to "simplify eligibility" by pivoting away from the tiered system announced in December in favor of an age-based system and work with a "third party administrator" — Blue Shield — to build a statewide vaccine delivery network that will allocate doses directly to providers.

On Feb. 26, the state announced that these changes will come in waves. The first began March 1, when Blue Shield, one of the state's largest health insurers, stepped in to assist vaccine distribution and oversight in 10 counties — eight in the Central Valley plus Imperial and Riverside — making recommendations to state health officials on how many doses should go to each and which providers should get them.

Blue Shield CEO Paul Markovich said these recommendations will be based on priority groups in the state's vaccination tiers and the stated goal of ensuring equity for disadvantaged communities. The health insurer is slated to step into the role for all 58 counties by the end of the month, with the state's most populace counties coming in the second wave and 20 others — including Mendocino, Humboldt and Del Norte — in the third.

The state's goal is to get to the point where 4 million vaccinations are being administered per week, a near tripling of the current weekly rate of about 1.4 million. (If Humboldt County saw a similar tripling of its current rate it would be receiving about enough doses weekly to vaccinate about 7,100 people.)

State officials have promised the new system will bring consistency, with vaccine eligibility looking the same in all counties and distribution moving at a similar pace throughout the state.

And that's clearly not happening currently. In addition to the varying paces of vaccine administration outlined above, counties have taken different approaches to determining who should take priority. For example, while some counties have made all residents over the age of 65 eligible, others — including Humboldt, where the threshold is currently 70 years old — have prioritized other groups. Some counties like Humboldt have prioritized vaccinating teachers, while others have not, creating a situation where a teacher working in one part of the state might be immunized while a counterpart in a neighboring county might not be even as they're teaching in person.

Blue Shield has reportedly contracted with at least 30 providers who will be putting shots into arms, including pharmacies, health systems and clinics, including Kaiser Permanente, OptumServe and Adventist Health. But little has been released about how this process will work locally.

While state officials hope Blue Shield's extensive experience working with doctors and care networks will allow the company to come up with a more efficient system, the biggest obstacle continues to be a sufficient supply of the vaccines to meet the goal of vaccinating at least 80 percent of the state's adult population — some 20 million people.

The good news is that drug company executives told Congress last week that vaccine production is ramping up, while President Joe Biden has pledged that every American who wants a vaccine will have one available to them by the "end of July."

Johnson & Johnson reportedly has 4 million of its single-dose vaccine ready to ship with another 20 million projected to be ready by the end of the month, while Pfizer and Moderna indicated they expect to double — and potentially triple — production by April.

But in the country's most populace state, exactly how those shots will get from pharmaceutical production lines into residents' arms remains murky at best.

CalMatters reporters Barbara Feder Ostrov and Ana B. Ibarra contributed to this story. CalMatters COVID-19 coverage, translation and distribution is supported by generous grants from the Blue Shield of California Foundation, the California Wellness Foundation and the California Health Care Foundation.

Thadeus Greenson (he/him) is the Journal's news editor. Reach him at 442-1400, extension 321, or [email protected]. Follow him on Twitter @thadeusgreenson.



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