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Since coronavirus vaccines became available in December, Sacramento County health officials have described their supply as “very limited.” As more people become eligible, there continues to be concern that there won’t be enough to go around.

Sacramento’s weekly allotment recently increased from 15,000 to 19,000 and again to 23,310. Rachel Allen, the county’s immunization program manager, says there’s no guarantee that they’ll continue to receive the increased amount, but Dr. Olivia Kasirye, the county’s public health officer, said she was “hopeful.”

The Sacramento OBSERVER recently spoke with Dr. Kasirye about some of the county’s challenges in its vaccination rollout.

Dr. Kasirye said the initial weekly allotment of 15,000 doses was low for a county of Sacramento’s size. The increase may also be insufficient, she says, with eligibility guidelines increasing April 1 to include individuals ages 50-64 old and again April 15 to include every Californian age 16 and older.

“We feel that we could very comfortably use 20,000 each week to begin with, and then, especially as we get to the general population, we could probably even use more,” Dr. Kasirye said. 

Put simply, she said, demand isn’t being met. “So that’s why you’re probably hearing a lot from people who are complaining that they’re eligible and they’ve tried to make an appointment,” Dr. Kasirye said. “We now have a website where we post information on available appointments, but those appointments are snatched up very quickly, so some people have had a hard time being able to get appointments.”

She explained how vaccines are allocated. The federal government reserves a certain percentage for commercial pharmacies such as Rite-Aid, CVS and Walgreens, as well as for the states, Dr. Kasirye said. In California, a percentage also goes to hospitals and other county entities.

“And then there’s an allocation that goes to each of the counties,” she said.

That allocation is based on a formula that changes periodically based on which groups are being prioritized. Dr. Kasirye used as an example an early focus on ensuring counties had enough doses to vaccinate health care workers. Vaccine allocations in that instance were made based on counties’ number of health care workers. When the focus shifted to agricultural workers, some San Joaquin Valley counties — where such workers are found in heavier concentrations — received more doses.

Dr. Kasirye said a new factor, and focus, is the “health equity quartile,” which is based on the system used for determining which ZIP codes and census tracts are considered underserved communities. “So the ones that are in the lowest quartile is what they call the health equity quartile,” she said. “When you look at COVID outcomes, these are the communities that had the highest rate of infection and some of the highest rates of hospitalizations and death.” Dr. Kasirye said such communities now are receiving 40% of the state’s vaccine allocation.

Eleven Sacramento County ZIP codes fall into that category. Dr. Kasirye said the county is notified of its weekly allocation on Tuesday or Wednesday and has until Thursday afternoon to put in the number of doses and how they want it to be allocated.

“What we do is we look at the list of approved providers in the state database and make decisions on how many doses each of those providers will get and then we also keep a certain percentage to be able to run the sites that we’re running such as Cal Expo,” Dr. Kasirye said.

Operation of the drive-thru vaccination site at Cal Expo recently was turned over to an outside partner, Curative, and has halted distribution of first doses to prioritize second doses. They expect to resume first doses by mid April, with the capacity to administer 3,500 first doses and add 3,500 second doses after about three weeks.

Many advocates have said the rollout of the vaccine has not been very equitable, citing disproportionate vaccination numbers throughout the state. As of March 30, Blacks account for just 3% of Californians who have been vaccinated. For some, getting the vaccine has been about “who you know.” At one point, the state provided general access codes to about 1,000 community groups so they could sign up residents for reserved doses at federally funded vaccination sites that opened in Los Angeles and Oakland.  But these group codes were shared over email and passed on, leading some people to sign up for shots who were not eligible because of their age or occupation. 

Another issue locally has been access to vaccination sites. Before the vaccines were available, Dr. Kasirye and former county Health Director Dr. Peter Beilensen said neighborhood testing sites set up in communities of color would likely be turned into vaccination sites. That has yet to happen. Dr. Kasirye said the issue in large part is attributable to vaccinations initially being prioritized by occupation. 

St. Paul was set to start vaccinations March 31.  La Familia gave out slot vouchers along with other community-based organizations such as the Sacramento NAACP that allow holders to receive vaccinations at the Sam Pannell Center during pop-up clinics hosted by District 8 City Councilmember Mai Vang.

Some have argued that if advocates in communities of color want to see people vaccinated, they have to make it happen on their own. Not so, said Dr. Kasirye, who added those will continue to operate in collaboration with the county.

“If it’s UC Davis, they might be the ones applying the vaccine and they might be the ones supplying the labor, but we’ve really been collaborating,” she said. “Many of the clinics, for example, when we went to the Pannell Center, we had people from the county and city health systems all pitching in to help.”

Limited vaccine allotment has caused distribution to take longer than expected, Dr. Kasirye said.

“I know that there’s a huge demand and we appreciate that everyone is so ready and willing to get vaccinated, but we need to be able to give them the vaccine and not let people get so frustrated,” she said.

Black physicians co-operating a clinic in Del Paso Heights along with the Neighborhood Wellness Foundation, say they have some 4,000 people on a waiting list for vaccinations.

“We had a long waiting list as well, especially when we first opened it up to people aged over 65,” Dr. Kasirye said.

Having three vaccines available is critically important, she said, as is their effectiveness.

“Especially now that we have such a limited supply of each of the vaccines, if you get an appointment, whatever vaccine they’re offering, get it,” she said. “The more people that we can get vaccinated, the sooner we’ll get to the point where we can control the spread of infection and get people back to their regular life.”