Rags to Riches

A 'shipping issue' led to a scramble to find vaccine, ultimately leaving Humboldt with a surplus



When a handful of officials at the forefront of the county's COVID-19 response sat down to a virtual press conference May 5, they made clear Humboldt County was at an inflection point. In sharp contrast to the rest of the state, local case numbers were ballooning, with the county having confirmed 267 new cases — and a rash of hospitalizations — over the previous 14 days as the state continued preparations to lift most pandemic restrictions and reopen its economy by mid June.

"We're still very much in the middle of this pandemic response," cautioned Public Health Director Michele Stephens. "I think we're all feeling really hopeful that the vaccine is here and we're getting shots in arms — it's certainly something we've all been waiting for. ... But we're not through this yet. We're still seeing cases, we're still seeing hospitalizations."

Health Officer Ian Hoffman followed up to say he'd seen a "change in the tide," fueled by the arrival of the virus' highly contagious B.1.1.7 variant on the North Coast, which sent case rates spiking.

"We are headed into a time where the protections, public health protections, that we've had throughout the whole pandemic are being taken away," Hoffman said, referring to loosening restrictions on business activities and gatherings. "The stay-at-home orders that were very strict in the beginning have continually loosened and will continue to loosen over time, so those protections won't be there for people. The last protection we are going to have are the vaccine and masking."

A few minutes earlier, county Vaccine Task Force member Lindsey Mendez mentioned the county had run into "a little bit of a shipping issue" with what had been projected to be an allocation of 6,600 vaccine doses from Blue Shield, the state's third-party administrator that's taken over vaccine allocation and delivery. Nearly 5,000 of those doses were slated to be put into arms at a series of mass clinics scheduled for residents expecting the second doses of the Pfizer and Moderna vaccines that are necessary for full efficacy and protection against severe disease and death. As such, the week's clinics represented a chance for the county to boost the number of fully vaccinated residents by 10 percent. A county press release later that day announced local officials had worked with the state to procure two trays of the Pfizer vaccine — 2,340 doses — from Fresno County, whose sheriff's department hastily flew them north. But the press release made no mention of the approximately 2,700 other doses that would be needed to fulfill the week's planned clinics, nor the all-hands-on-deck effort unfolding behind the scenes to find them.

Megan Montgomery, a Public Health program coordinator who serves as the MyTurn Unit Leader for the county's COVID response, said the problem arose with a change to the ordering process under Blue Shield that created confusion.

"The outcome of this confusion is they thought we didn't want our vaccine, when we in fact wanted it shipped to St. Joseph Hospital," Montgomery said, adding that when the misunderstanding became apparent, Blue Shield indicated it would make good on the shipment by the weekend's clinics.

The two trays of Pfizer vaccine offered up through Sierra Pacific Orthopedic in Fresno — would be enough to make it through planned weekday clinics with a bit of rescheduling, but thousands of additional doses would be needed to make good on weekend appointments. Adding urgency to the situation was the fact that these were scheduled second doses, which have to be given within a specific number of days of the first dose or there isn't clear evidence of efficacy, Montgomery said.

And officials are aware that any additional barriers — like having to reschedule set appointments or cancel clinics — makes it more likely some people won't follow up on getting their second doses.

"We do all we can to really honor those appointments whenever possible," Montgomery said. "We're really committed to delivering those second doses to our community and it's really important for us to be accountable to our community in that way."

Montgomery said Blue Shield indicated it would make good on the waylaid shipment by the end of the week but there were "a lot of different actors" involved and the company wasn't able to provide local officials with tracking numbers to confirm the doses were on their way.

"We reached a point where the health department decided to pivot and look at some of those other partners," Montgomery said, adding that officials then worked through the third-party administrator to find any other counties or facilities that may have available doses. St. Joseph Health, which had gotten its own independent vaccine supply, had enough Moderna doses on hand to meet the county's demand, so the focus was on Pfizer.

Public Health officials heard Mee Memorial Healthcare System in Monterey County might have two trays of Pfizer available, so they made the call.

"When we contacted them, it turned out they actually had four that they offered us," Montgomery said.

The challenge then was getting those doses 380 miles north while meeting cold-chain storage and chain of custody requirements. There wasn't enough time to work with FedEx or the U.S. Postal Service Montgomery said, so officials called the California Department of Public Health, which agreed to provide ground transportation.

Ultimately, the county was able to meet all scheduled appointments through the weekend with minimal disruptions.

"It was, I think, really successful," Montgomery said.

And the Blue Shield shipment ultimately showed up, too, leaving the county extremely well poised to meet vaccine demand moving forward. Even after taking into account scheduled second-dose vaccine clinics through May 24, Montgomery said the county currently has a stockpile of more than 6,000 doses on hand.

"This makes sure that we definitely have the supply that we need," she said, adding that the timing is especially fortuitous with the U.S. Centers for Disease Control and Prevention expected to allow states to begin vaccinating 12 to 15 year olds with the Pfizer vaccine as early as May 13.

While the miscommunication between Blue Shield and county Public Health that led to last week's scramble is potentially concerning, Montgomery said she's "feeling confident" that there's a strong partnership moving forward.

"In the meantime," she added, "we have enough vaccine in-county to bridge any issues."

Looking back over the week's events, Montgomery said the outcome is a testament to hard work, collaboration and partnership.

"We really all worked together to make this possible," she said. "It really speaks to how many people are working so hard to make sure everyone across California who wants to get vaccinated can."

It's also worth noting that while Humboldt County was on the receiving end of vaccine generosity, it has been on the giving end before, having donated more than 1,000 doses of Pfizer vaccine to San Francisco last month.

Back at the May 5 press conference, officials stressed that getting as many people vaccinated as possible is ultimately what will guide the path out of this pandemic, noting that the vaccine is being shown to almost entirely eliminate the risk of severe illness, hospitalization and death. The county's efforts are moving away from the larger mass vaccination clinics in population centers to focusing on mobile clinics in outlying areas and less traditional settings in an effort to reach residents with transportation issues and meet people where they are, and where they're comfortable.

Pfizer and Moderna have also begun the process of seeking full approval for their vaccines on top of the emergency use authorization currently in place. During the press conference, Hoffman said this would alleviate many of the restrictions that limit current vaccination efforts to "very select settings" and allow all doctor's offices, medical clinics and pharmacies to begin offering them, enabling residents to have discussions directly with trusted providers and pharmacists before immediately getting the vaccines, if they choose.

"This is the thing that helps keep our community safe," Stephens said. "We're going to continue to see COVID-19 cases. It's here. It's here to stay. But we're going to get through it and we just want to continue to save lives and prevent severe disease. Vaccine is the way to do that. Just like we did with polio, just like we did with measles, just like we did with a lot of communicable disease that we don't see anymore."

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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