COVID-19 Vaccines, Blue Shield and The Health Departments: The Saga of Medico-Political Infighting

social@drbretsky.com
social@drbretsky.com

You may remember that back in January, Governor Newsom announced that Blue Shield of California (a health insurer who has contributed heavily to his campaign and inauguration committee – pointed out as a statement of fact, nothing more) would take charge of COVID-19 vaccine distribution in the State.  The stated goal was for Blue Shield to leverage their existing provider network to speed vaccine delivery and distribution.

Nothing of the sort has happened and, instead, only one California County (Kern) has signed a contract to work with Blue Shield.  Some (Santa Clara County) are in bold defiance of the move while others (San Diego) perhaps hope to fly under the radar by staying silent. Yesterday, the State Health Department stepped into the fray declaring that that counties would no longer retain control over how vaccines are distributed within their borders under the state’s new, centralized vaccination system. Instead, the spokesman said, the state would determine which hospitals, clinics and other groups get vaccine supply, relying on recommendations from Blue Shield. 

“That’s a bit of a surprise,” Santa Clara County Executive Jeff Smith said in response “But that just proves the problem, that they’re relying upon an insurance company to make recommendations about distribution that are related to populations that we normally take care of. We know where the populations are, we know who the players are, we know who the vaccinators are, and they’re going to ask a private corporation to give them advice? It’s absurd.”

Here in Los Angeles, County Health Department Director Dr. Barbara Ferrar voiced a similar opinion:

“Public health will continue to play a lead role because we are the local government entity tasked with vaccination in the county,” Public Health Director Barbara Ferrer told the county Board of Supervisors during a public meeting on Tuesday, March 9.

She went on to say, “I’m really comfortable with our provider network and the people we work with on the ground,” she said. “Those are the people I rely on the most when I think about how to solve problems of equity for a scarce good.”

My interactions with both the County and Blue Shield have been so disappointing that it has changed my answer to the most common question I get from patients: “when will you have the vaccine?”  My answer has gone from “probably March” to “maybe Summer” to now, “quite possibly never.” Despite our clinic having both State and CDC certification to store, administer and electronically report vaccines given, the County has steadfastly rebuffed our efforts to become involved. The response from Blue Shield provided little additional optimism:

“We are moving as quickly as we can to review and process all of the requests that we have received from many community based providers.  Due to the high level of interest, we anticipate processing requests for the next several weeks, and we will greatly appreciate your patience.”

This medico-political infighting serves to hurt only the public. Point in fact, Los Angeles County has done a terrible job of addressing Dr. Ferrar’s stated challenge of “equity for a scarce good.”  African-American residents comprise nearly 8% of the population yet have received only 5.4% of the vaccines.  Latinx residents make up 45.6% of the population but have received only 23.1% of the vaccine.  By contrast, those that are White (25.9% of the population; 33.5% of the vaccine) and Asian (14.6% of the population; 18.8% of the vaccine) have been disproportionately vaccinated.

These inequities are magnified when you turn to the over 65 population which has been primarily prioritized in these initial months. Whereas 47.8% and 44.6% of White and Asian seniors have received at least one dose of the vaccine, only 28.9% and 34.3% of African-American and Latinx seniors have received one dose (source: http://publichealth.lacounty.gov/media/coronavirus/vaccine/vaccine-dashboard.htm).

Santa Clara County which, apparently is too knowledgeable to take advice from any outside source, displays a similar magnitude of inequity.  It has only provided vaccines to 16.7% of its African-American residents and 10.1% of its Latinx residents.  Among White and Asian individuals these percentages are far higher:  21.8% and 23% respectively – both more than two fold as compared to Latinx (source: https://www.sccgov.org/sites/covid19/Pages/dashboard-vaccine-CAIR2.aspx)

So neither Los Angeles nor Santa Clara are doing well with equitably distributing vaccines but they don’t want help.  Here we are three months from FDA approval of the Pfizer/BioNTech vaccine and have two additional vaccines available – but only 12.4% of the Los Angeles County population has been vaccinated.  At least in Santa Clara, that percentage is higher at 21.4%.

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