California's COVID-19 Vaccine Plans: The Tension Between Speed and Equity

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 (Ariana Drehsler / AFP via Getty Images)

Information about California’s COVID-19 vaccine rollout is changing quickly. The links below will keep you up to date. Bay Curious episode transcript below.

COVID-19 Vaccine Resources:


Katrina Schwartz [00:00:01] When we started hearing back in December that there was an effective coronavirus vaccine, I got really excited. I started to imagine that by summer or fall, my life might start to actually look more normal again. And I even started thinking about plans for the future. Now about a month into the vaccine rollout, I’m a little less hopeful. The messaging about the vaccine has been confusing and the whole thing feels really chaotic. My parents, Tim and Sandra Schwartz, have had very different experiences trying to get the vaccine.

Tim Schwartz [00:00:34] It’s frustrating, we hear 65 and older, let’s say, is eligible for a vaccine. You go to the website and it says, “Don’t bother calling. You’ll be on hold for hours and hours. We’re vaccinating 75 and older. We’ll let you know.”

Sandra Schwartz [00:00:49] I’m a volunteer with hospice. And they decided to vaccinate everybody, from their people who work in the kitchen through their doctors and nurses to their volunteers. So I got a call from the volunteer coordinator and she said, you have an appointment tomorrow morning.


Tim Schwartz [00:01:05] Apparently in other counties, they’re vaccinating 65 year olds. Well, why is that? And can I go over there and get vaccinated?

Katrina Schwartz [00:01:14] First the vaccine was only available to healthcare workers and that made sense. But then there were plans to focus on groups that were hit the hardest by the pandemic. Now it’s all about age. Today on the show, what’s going on with California’s vaccine rollout and why has it felt so chaotic? I’m Katrina Schwartz and this is Bay Curious.

Katrina Schwartz [00:01:41] California health officials originally said they intended to focus vaccines on the most vulnerable groups, but that plan has been changing quickly. KQED’s health correspondent April Dembosky is here to explain what’s going on. Hi, April.

April Dembosky [00:01:56] Hi, Katrina.

Katrina Schwartz [00:01:57] OK, so the state knew that a vaccine was coming months before it was actually approved. So shouldn’t they have prepared for this moment?

April Dembosky [00:02:05] Well, yes and no. California did do a lot of planning. But when you have a federal government that keeps changing things up, it can be hard to keep up. And that’s the biggest failing of the vaccine rollout, is the utter lack of national leadership. So the Trump administration did an amazing job of getting the vaccine made in record time. It had vaccines ready to ship the moment it was approved by the FDA. But after that, once it got to the states, there was no plan. And so instead, you have 50 states making up 50 plans. And in California, we have 58 counties with 58 plans. So everyone is making this up as they go along. Also, keep in mind that we’ve been trying to do this at the same time that we’ve been in the middle of our biggest surge of the pandemic. Hospitals have been maxed out and the health care system has not had a ton of resources left over to also manage a mass vaccination effort. And until recently, there was no money from the feds to really prepare. So let me put it this way. At every turn in the pandemic, the U.S. has responded poorly. We’ve been slow and uncoordinated with testing, contact tracing, prevention, masks. And it’s the same public health system for the vaccine. So I think the expectation that this would ever happen quickly and smoothly was a little unrealistic.

Katrina Schwartz [00:03:26] But you said that the state did do a lot of planning, so why wasn’t that enough?

April Dembosky
[00:03:30] So I think it’s fair to say that the state didn’t fully think things through. So, yes, starting in November, the state convened the Community Vaccine Advisory Committee and they invited 70 different groups to be part of it. Advocates for farm workers, teachers, the elderly, as well as health insurance groups, hospital groups, county health departments, across the spectrum. And the main goal of this group was to figure out who should get the vaccine first. So we’ve known from the beginning that there wouldn’t be enough vaccines for everybody. And so who should get priority? So this group put a ton of thought into this. They were balancing, risk and exposure and societal impact. And they came up with a very detailed plan that was centered on equity and fairness. So the first phase, health care workers. But it also had all these tiers for which health care workers were most at risk and should be first. And that also included sending vaccines to hospitals in low income neighborhoods first. So the second phase, the state prioritized mainly essential workers, farm workers or meatpackers who had no way of working from home. But it turns out that all that detail was just too complex to actually put into operation on the ground. And by the time the state plan got to the counties, there was hardly any time left for them to figure out how to actually implement it. Denny Chan is an attorney with Justice in Aging and a member of the vaccine committee.

Denny Chan [00:04:58] “We have been so caught up in some of the minutiae of what sectors in which phase, but we don’t seem to be spending the same amount of time and consideration on thinking through how you’re going to get to those people ultimately in the end.”

Katrina Schwartz [00:05:30] This whole pandemic has shown us over and over again how inequitable and fragile the U.S. healthcare system is and getting vaccines to people has been no exception. So can you help us to understand why it has been so hard for California to actually follow through on its good intentions and to be more equitable?

April Dembosky
[00:05:48] I would say it comes down to logistics and leadership. So let me give you a couple of examples. So this vaccine needs to be stored at very low temperatures. And once you allow a batch to thaw, you have to use it within a few hours or it’s no good. So you have a situation where hospitals had vaccine ready to go, but not enough people from the priority groups ready and willing to be vaccinated. That’s where you have hospitals putting out word to their own friends and family, ‘Hey, come get the vaccine or it’s going to go to waste.’ There is another example of a hospital in San Jose where the hospital administrator called up a local school superintendent and said, ‘Send over your employees,’ even though it was not their turn yet. So stories like these start filtering out. And at the same time, you have those 50 states with those 50 plans. And so over here in California, we start hearing stories about older people in Florida getting the vaccine first. So, older Floridians are a large Republican voting bloc. And so there’s been some talk that that’s why the governor there went his own way and put them first. But either way, older people here in California start deluging the state, ‘What about us?’ So you have these logistical complications combined with this political pressure to speed things up. So this is the point where Governor Newsom opens up vaccinations to all people 65 and over.

Katrina Schwartz [00:07:11] OK, so what’s the rationale behind the change, like moving to this age-based system? Why that?

April Dembosky [00:07:17] So there are two reasons. And the main one, which is a very powerful one, is that people 65 and older are the most likely to need hospital care if they get Covid and the most likely to die. They account for 75 percent of Covid deaths in the state. And so the thinking is, if we can quickly start vaccinating this group, maybe we can actually start to impact both the death toll and the toll on our overwhelmed hospital system. So the other reason to do it this way is because health officials have said it’s easier. It’s a clear message to communicate to the public and there’s data for it. So health insurers don’t have reliable data on who’s a farm worker, for example, or who’s a teacher. You know, many farm workers are uninsured, but they do have data on who is 65 and over.

Katrina Schwartz [00:08:05] So now the governor has opened up vaccinations to folks over 65 and that’s over 6.2 million people. Will that just make it harder for less privileged people to get the vaccine?

April Dembosky [00:08:17] At first, it’s definitely going to make it harder. Remember, this was not part of the original plan. Some counties had already started setting up vaccination clinics for teachers or first responders or farm workers. And now there’s this last minute change. And so it’s hard for counties to just turn on a dime and suddenly do something different. And that’s part of the reason we’re hearing all sorts of stories of the struggles that seniors are having, getting a vaccine, people waiting on hold on the phone for eight hours to get an appointment. People refreshing their web portal over and over and over again to try to register online for an appointment or driving two hours to a clinic, because that’s the only place where you could get an appointment. So if you don’t have a computer or a family member who can help you with this, it’s too hard. You have to fight. And so this is inherently going to favor people with time and means to navigate the system. There was a recent study that was investigating racial inequities in heart failure treatment, and it showed that white patients were more likely to receive specialty care. And the reason that they found was because white patients were more likely to vigorously advocate for access to that care. I talked to Dr. Michelle Morse from Harvard Medical School. She worked on the study and she said the same thing is likely to play out with vaccines.

Michelle Morse [00:09:37] “Folks who are white do feel that they are entitled or feel that they should have access to certain things that, you know, other groups have either been told that they shouldn’t have access to or actually have been intentionally excluded from having access to.”

April Dembosky [00:09:54] We are already seeing this play out with the first group that got vaccinated, health care workers. Kaiser Health News did an analysis of 16 states that have been tracking race data and vaccinations. And so far in all of them, white people are being vaccinated at much higher rates than black people. In many cases, the rate is two to three times higher for white people. So some of the reasons are similar to what we’re seeing now with computer access. At one hospital in Virginia, for example, notifications about vaccine registration went out by email. Well, it turned out the janitorial staff there did not have access to email, so structurally our systems are leaving people of color out.

Katrina Schwartz [00:10:50] So I have to say, when I first heard that California was trying to be thoughtful about the vaccine distribution to prioritize populations who’ve been historically disadvantaged or who have already borne the brunt of this pandemic, I was actually really hopeful about that. I mean, it seemed to me like a new way of thinking about health care, one that takes a bit more of a holistic approach. So it’s kind of disturbing to watch all of this fall apart. Is there any way that this could have gone better?

April Dembosky [00:11:18] It’s hard to say. And I think part of what’s tricky is that, the state did set out to do that and set up a lot of expectations. That is now leaving a lot of groups disappointed. But, could it have gone better? I mean, reaching hard to reach populations takes time. You have to build trust. And in general, it’s better to go to those communities rather than asking them to come to you. And as much as advocates know that this is the path to follow, our current healthcare system is just not set up for that. And right now, there’s so much impatience and so much urgency to move fast. So I think the real issue is the fact that the state changed its plan at the last minute. We’ve known all along that vaccine doses were going to be scarce. So in some ways, we could have seen this coming and it seemed like the state wasn’t really willing to say at any certain point, no, your group will not be prioritized because they can work from home or they can mitigate their risk. And, seniors are the ones who are dying. But at the same time, it’s not that the state is, going to drop all concerns about equity. It is still thinking about this and talking about this. You know, if they’re going to direct vaccines to seniors, how do you direct them to seniors who live maybe in low income areas or to areas of the state that have been hit hard by the pandemic? Some counties are working on mobile clinics that can bring the vaccine to the most vulnerable communities. And now more recently, the state has said it is it has finally said it’s it’s taking the reins. It’s saying it’s going to lead distribution at the state level. It’s creating a statewide registry called My Turn, and it’s going to coordinate the delivery and keep data on who’s getting the vaccine. So on some level, that’s going to streamline the process and also hopefully make it easier to track and implement an equity plan. The other thing that I’ll say is that we also have a new administration coming in at the federal level. And the Biden administration has absolutely signaled that they’re going to do more to take on national leadership around vaccine distribution. So a lot of things really could be changing. The one thing I will say is that I do think we’re going to get better at this.

Katrina Schwartz [00:13:39] Good. A note of optimism to end on. Thank you so much, April.

April Dembosky [00:13:42] Thanks, Katrina.

Katrina Schwartz [00:13:43] That was April Dembosky, KQED health correspondent. Information about the coronavirus and the vaccine’s. It’s changing all the time, like April just said. So the best place to find answers to your practical questions is online at KQED. Dawg, our colleagues have been answering your questions about where to get the vaccine, who’s eligible, and making sure that it’s all up to date. So that’s really the place to go for the nitty gritty.

Katrina Schwartz [00:14:12] KQED is looking to learn more about how you listen to podcasts and what you love about them, so if you have ten minutes to spare, could you please take our survey? It would help us a lot and give us really valuable feedback. All you have to do is go to It’s all one word. I’ll put a link in our show notes. Bay Curious is produced by Suzie Racho, Katie McMurran and me, Katrina Schwartz. Our show is a production of member-supported KQED in San Francisco. See you next week.