Rural California county pushes back on state vaccine plan. Why big cities are worried, too

If you’re 18 or older — rich or poor and regardless of occupation — you can receive a COVID-19 vaccine next week at a drive-up clinic in one sparsely populated rural county in the high desert of California’s northeastern corner.

All you need is proof that you live in Lassen County.

With its straightforward announcement this week, Lassen joined a growing rebellion against a state-run vaccination program that prioritizes eligibility according to age, occupation and a community’s poverty level — a rollout that’s been widely criticized as glitchy, convoluted and painfully slow.

With the state poised to take even greater control of vaccination distribution, through a contract with health insurer Blue Shield of California, leaders of Lassen County, population 30,573, decided to institute a simplified system of first-come, first-served — without regard to the priorities of Gov. Gavin Newsom’s administration.

“Prior to this new one-size-fits-all program that they’re trying to implement, we’re just trying to vaccinate as many people as we possibly can,” Richard Egan, the county’s chief administrative officer, told The Sacramento Bee on Tuesday.

From the start of the pandemic, local government officials have pushed back against statewide business closures and other health edicts from Sacramento, with much of the opposition coming from rural California.

When it comes to vaccines, the pushback isn’t limited to Republican strongholds like Lassen. Counties across the state, urban and rural, are opposing the governor’s ever-changing vaccine distribution plan, including a new allocation formula designed to boost supplies in low-income areas and the decision to hire Blue Shield.

Bay Area counties, in particular, are protesting Newsom’s latest directive, requiring that 40% of all vaccines go to residents of the state’s most economically disadvantaged ZIP codes, as defined by California’s “Healthy Places Index.” The index measures health indicators of a community that influence life expectancy, such as income, grocery store and health insurance access, homeownership, education levels, and more.

The state says the plan will “double the amount of vaccines allocated to the lowest 25% of zip codes.”

But because of the region’s high cost of living, the plan cuts out much of the Bay Area, where about one in every five Californians live. Santa Clara, San Mateo, Marin, Sonoma and Napa counties have no ZIP codes that fall in the disadvantaged category, according to an analysis by the San Francisco Chronicle.

At a supervisors meeting Tuesday, Santa Clara officials complained that the allocation formula overlooks depressed pockets of Silicon Valley that badly need the vaccine.

“This masks the many census tracts that have … been hit very hard by COVID-19,” said county counsel James William. “We hope the state will reexamine that.”

Few takers on Blue Shield plan

Meanwhile, counties up and down the state are upset with Newsom’s $15 million agreement with Blue Shield to administer the distribution system.

Kern County was the only county that has signed a contract with Blue Shield. Others, including San Joaquin, Santa Clara and Los Angeles, say the Blue Shield arrangement would create confusion and complexity at a time when county officials say they’re finally making progress on getting shots in lots of arms after a rocky start.

“All of the counties feel, at this point, they have really strong public health departments,” said Dr. Barbara Ferrer, L.A. County’s public health director, at a Board of Supervisors meeting Tuesday.

Blue Shield’s involvement would add “layers of bureaucracy,” she added. The county appealed directly to Newsom last week for the right to opt-out of the Blue Shield relationship.

Before the Blue Shield deal came along, “we were really ramping up our capacity,” Dr. Maggie Park, San Joaquin’s interim public health officer, told the county’s supervisors late last month.

Dealing with Blue Shield makes the system “quite bureaucratic and complicated,” she said. Among other things, the state is requiring counties to use the state’s much-criticized “My Turn” system for scheduling appointments.

On Tuesday, San Joaquin’s general counsel, Mark Myles, said officials from several counties have begun talks with Newsom’s staff “to explore the possibility of contracting directly with the state instead of with Blue Shield.” He said he’s hopeful San Joaquin and the other counties will be able to skip out of the Blue Shield deal — to the delight of his Board of Supervisors, whose members have blasted the plan as a “power grab” by the state.

“Local control,” said Supervisor Robert Rickman. “We can do things better than they can.”

Similarly, Santa Clara Supervisor Susan Ellenberg said it appears the Newsom administration “has backed off” on requiring counties to work with Blue Shield.

For its part, Blue Shield said that while only one county has signed on, 69 hospitals and medical clinics have agreed to work with the insurer, as well as three pharmacy chains.

“We continue to work diligently with local, county and state officials, healthcare providers, and other important stakeholders to build an enhanced state vaccine network to increase capacity and support the state’s goal of being able to administer 4 million doses a week,” Blue Shield spokeswoman Erika Conner said in an emailed statement. “We are also finalizing agreements with counties, including equity plans that engage community-based organizations to help ensure all Californians have access equitably, efficiently and safely.”

Officials in some parts of California say they’re having more problems getting vaccines than distributing them. Last week, Sutter Health had to postpone as many as 90,000 appointments for second-dose vaccines because of a supply shortage.

Asked about the Blue Shield arrangement, Sacramento County spokeswoman Brenda Bongiorno said in an email that the county is working with the state and the insurer “on how to best implement the roll-out.” She added, ”Ultimately, our priority is to make sure that Sacramento County gets an appropriate share of vaccine doses for our residents.”

The opposition to the state’s latest vaccine distribution plan comes as California’s vaccine rollout continues to gain momentum as more vaccines get delivered, though at a slightly slower pace than the rest of the U.S. According to data compiled by the U.S. Centers for Disease Control and Prevention, about 18.5% of state residents have received at least one dose, slightly better than the national average of 18.1%. Only 8.6% of Californians have been fully vaccinated, below the U.S. average of 9.5%.

Newsom vigorously defended the state’s distribution system in Tuesday’s state of the state address from Dodger Stadium, now a mass vaccination site. The governor said California has “the most robust vaccination program in the country” but added: “I know our progress hasn’t always felt fast enough.”

Will others follow Lassen’s lead?

Rebelling against the pandemic edicts coming out of Sacramento is nothing new for Lassen County.

Last month, the county announced it was severing ties with OptumServe, a company Newsom’s administration had hired to run the state’s recently revamped COVID-19 testing program. In a scathing letter to Newsom’s team, the county’s health officials blasted the company for being disorganized, testing far fewer people than the county had been testing on its own, and for not following proper health protocols.

The Newsom administration pushed back strongly against the claims, but Egan, the county’s executive officer, said state officials didn’t formally respond to Lassen’s decision to sever the relationship.

Now Lassen appears to be the first county in the state to start giving out shots to any resident who wants it, regardless of age, job or other categories.

Lassen is not very wealthy and not particularly healthy, and portions of the county are in the bottom quarter of the state’s Healthy Places Index – meaning they’re supposed to get a boost in supplies under Newsom’s plan to prioritize low-income ZIP codes.

But in rural Lassen, where suspicions about Sacramento run deep, county officials said they wanted to get their residents vaccinated quickly, before Newsom’s arrangement with Blue Shield takes hold. County officials feared their residents would lose access to shots under a system that gave additional power to the state.

Egan said his county can only take its rebellion so far, given the state controls the vaccine supply.

“We don’t have an independent source for the vaccine, or, obviously, we would probably break away from the state and just do it ourselves,” he said.

While many are concerned about the state’s updated vaccine plan, most counties aren’t willing to take it as far as Lassen.

“Our health department worries about (the state) withholding funding or coming after us, you know, in some manner on the fiscal side, and so we’re walking in line,” Butte County Supervisor Bill Connelly said Tuesday. “We just don’t appreciate where we’re at. I understand exactly why a smaller county could get away with that, but I don’t think we could.”

Humboldt County Supervisor Rex Bohn said his North Coast county has no plans to break away from the state’s system either, despite the frustration that “the rules keep changing — the tiers, the colors, the everything — and it’s going to change again.”

He said he sympathizes with what the Newsom administration is going through, since “this is the first time any of us have gone through anything like this.”

Even so, he said, the state is “spending so much time thinking about who should be first, where we should just maybe just be getting people to vaccinate, knowing that the vaccines are going to come within a six-week period.”

This story was originally published March 10, 2021 at 5:00 AM with the headline "Rural California county pushes back on state vaccine plan. Why big cities are worried, too."