Ana B. Ibarra | CalMatters
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California is opening COVID-19 vaccines to all residents 65 and older — an announcement that comes amid a slower-than-expected vaccination rollout and growing frustration among seniors most vulnerable to the virus.
State health officials had previously declared that California would focus on vaccinating health workers and nursing home residents, with seniors 75 and older and certain essential workers to follow. But people over age 65 make up the majority of hospitalizations and nearly three-quarters of the COVID-19 deaths.
“With our hospitals crowded and ICUs full, we need to focus on vaccinating Californians who are at highest risk of becoming hospitalized to alleviate stress on our health care facilities,” Dr. Tomás Aragón, director of the California Department of Public Health, said in a statement.
The federal government this week directed states to open vaccinations to people 65 and over and to people under 65 with a preexisting condition, noting that many states were being “too prescriptive” and not distributing vaccines fast enough.
California’s new guidelines do not include people under 65 with preexisting conditions. State officials have not yet explained that decision to deviate from the new federal recommendations.
The state has about 6 million people who are 65 and older, but has only received 2.8 million doses. And health workers and nursing home residents are still being vaccinated. So while supply is expected to ramp up, access is still likely to be limited for those newly eligible. Also, distribution could differ by county and even by health providers, which are responsible for on-the-ground distribution.
The state guidelines are recommendations, leaving actual decisions up to the counties.
For now, some counties, such as Santa Clara, have said they will follow the original plan of vaccinating people 75 and older first because they’re unsure of how many more doses they’ll receive in the coming weeks. Riverside County health officials said they’ll be adopting the state’s new recommendation and have scheduled a vaccination clinic at Diamond Stadium for this weekend that will serve only people 65 and over.
Others have expressed frustration about the change in direction.
In an emailed statement Tulare County health officials said: “We, like many of our residents, are frustrated with the continual changes in direction and prioritization at the State level and have concerns that current vaccine supply is insufficient to effectively accomplish the goals of vaccinating all individuals aged 65+ in the community, along with all of our critical workforce.”
Next week, the state will launch a text-and-email notification system so Californians can keep track of when they’re eligible to sign up for their shot, according to the state’s public health department.
The announcement comes a day after the U.S. Department of Health and Human Services Secretary Alex Azar declared that the federal government would no longer reserve doses for the second shot — both the Pfizer and Moderna vaccine require two doses.
Production has reached a point where there is now enough to start releasing more doses to states as they become available, Azar said.
As of Tuesday, California had administered just over 816,600 doses — about 30% of the doses it’s received, according to the state’s public health department. A federal tracker shows that most states are vaccinating people at a faster rate than California.
Last week, Gov. Gavin Newsom set a goal to administer an additional 1 million vaccines by this weekend, enlisting four mass vaccination sites: Disneyland Resort in Anaheim, Dodgers Stadium in Los Angeles, Petco Park in San Diego and Cal Expo in Sacramento.
While the shifting federal guidance throws the state off its meticulously designed vaccine tier system, more vaccine allotment is good news for the state, said Dr. Mark Ghaly, the state’s health secretary, in a press call on Tuesday.
“Having more vaccines, inviting more to be vaccinated, will allow California to go faster and quicker through our population and get that vaccine out of our freezers and into the population to get that protection,” Ghaly said.
Today, 47 legislators sent a letter to Gov. Newsom, asking him to provide counties a forecast of how many vaccines they’d be receiving in the coming weeks so that counties could better plan, among other suggestions.
André Rivers, for one, is anxious to get her COVID-19 vaccine. The 74-year-old has asked her primary care doctor and her rheumatologist when she’ll be able to get one. Neither has been able to provide an answer.
Her wife, Carly Rivers, who has Alzheimer’s, got hers last week through the Berkeley PACE Center, part of a state program that helps seniors coordinate care so they can live in their own home instead of a skilled nursing facility.
“Now that Carly has it, it makes sense that I should have it; we do everything together,” Rivers said. “When I do go out, she goes with me.”
Instead Rivers, like many other seniors in California who have spent the last 10 months mostly isolated from friends and family, has been patiently waiting her turn. The frustration and anticipation growing.
COVID-19 has taken the biggest toll on older adults. Early in the pandemic, seniors were advised to shelter in place because of their vulnerability, even before the entire state went on lockdown. In California, close to 75% of all COVID-19 deaths are of people 65 and older.
Soon after vaccines began to arrive in California, counties reported they were inundated with calls from older residents seeking information.
From day one, California vowed to distribute vaccines in a fair manner, carefully targeting people based on risk. But those equity efforts have hindered distribution.
“Part of the process we’ve set up in California — really thoughtful, trying to focus on risk and exposure and equity — have led to some delays in getting vaccines out into our communities,” Ghaly said.
Secretary Azar said states are being confined by the original guidance from the Centers for Disease Control’s immunization advisory committee, which recommended that states target health workers and nursing homes first.
“Some governors have overreacted and have taken them in an overly prescriptive manner and this is a logistical issue, it’s an operational issue,” he said. “If you try to be too micromanaged, too tailored, too focused, you let the perfect be the enemy of the good in a mass vaccine campaign like this.”
Some counties did not wait for state instruction. Following the federal announcement, Orange County announced on Tuesday it would start offering vaccines to residents 65 and over.
Orange County’s public health officer, Dr. Clayton Chau, said he made the decision after reviewing hospital and mortality data. According to the county’s findings, 72% of patients in intensive care units are 60 and older.
“My aim is to reduce hospitalizations and deaths as rapidly as possible, and we must prioritize our vaccine allocation to protect the most vulnerable in our community,” Chau said in a statement.
Orange County urged residents not to show up to its distribution sites without appointments, noting sites already were being overwhelmed.
State vaccine advisory commission member Denny Chan, an attorney for Justice in Aging, which advocates for low-income seniors, said that while he is glad to see more seniors prioritized, there are still immediate concerns with people in nursing homes — many of these facilities are still awaiting vaccines, he said.
“We also have not heard a strong response on how to reach homebound older adults who can’t drive to Disneyland or Dodger Stadium,” he added, noting that many older adults don’t have reliable transportation or live too far from the vaccination sites.
“We really need to think about how we’re going to reach those people.”
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.
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