California county giving first-come, first-serve alerts for excess COVID vaccine doses

Facing slow progress all throughout the state and the prospect of unused COVID-19 vaccines going to waste, a Northern California county had an idea.

Earlier this week, El Dorado County set up a web portal letting residents sign up for notification alerts to be sent when there are surpluses of shots available.

“No matter what Phase/tier you’re in, if you want a vax & can get to our Public Health office (Tahoe or Placerville) w/in 30-60 minutes, sign up for a text or phone alert!” the county announced in a Monday morning Facebook post.

It was a popular idea — maybe a little too popular.

On Wednesday, the county suspended new sign-ups for the alert program after 17,000 residents signed up in the first two days — nearly double the 10,000 vaccine doses El Dorado had been allotted as of that time, which are still being distributed in part to Phase “1A” recipients. Phase 1A includes critical health care workers and long-term care residents.

“Due to an overwhelming response by the public to be notified of the availability of a surplus vaccine administered via our Public Health offices, there are currently more sign-ups than we have allocated vaccines and therefore (we) have closed this option,” a note on the county website reads.

County spokeswoman Carla Hass said Thursday that El Dorado does not yet have a count of how many of the 17,000 residents have received surplus doses or notifications under this new system.

Hass said everyone who has already signed up for the “optimization list” and has not been alerted will remain in the queue, though “several” people on the list who are 65 or older became eligible within the normal phase system Wednesday, when the state updated its guidelines to accelerate shots in that age group.

But why are counties like El Dorado, among many others, faced with a need to offload extra doses with “30-to-60 minute” urgency?

The two vaccines currently approved for emergency use in the U.S. are by Pfizer and Moderna. Both are mRNA vaccines, which must be stored at very cold temperatures long-term, in special freezers; and when shipped long distances, transported in temperature-controlled packaging.

Ultracold storage freezers are sparse, and they’re not evenly spread out within California. There’s one at UC Davis Medical Center in Sacramento, which is being used as a local repository. There are also some whose locations have not been made public for security reasons.

Once shipped out and moved into a refrigerator, Pfizer’s vaccine are supposed to be discarded after five days, while Moderna’s vaccine can be kept refrigerated much longer, up to 30 days, according to the U.S. Centers for Disease Control and Prevention.

According to federal guidelines, thawed vaccines cannot be refrozen. That means the clock starts ticking the moment vials, which are still being distributed in very limited supply, are placed in fridges.

By the end of the use-by date, it becomes a use-it-or-lose-it situation for unadministered vaccine doses. Allocated shots can go ungiven for a variety of reasons related to scheduling and supply vs. demand — and, on top of that, vials contain more doses of vaccine than they are labeled for, to account for potential problems like spillage. Given the dire nature of the coronavirus crisis, health officials have said vials’ excess doses can and should be used.

“When the initial clinics were conducted, before it was widely known, clinics were getting additional doses from the vials of vaccine,” Hass explained in an emailed response to The Sacramento Bee. “There was a clinic in which there were approximately 5 doses remaining and several Phase 1A Tier 1-3 partners were called to make sure the doses were optimized.

“In an effort to reduce time to ‘find’ a person that meets the vaccine Phase/Tier Requirement ... El Dorado County decided to create the optimization list.”

The vaccination process has been off to a messy start across California. Both El Dorado’s surplus system and the fact that it became necessary in the first place are reflections of the rollout’s improvisational nature to this point.

As of Thursday morning, some of the most pertinent details about El Dorado County’s currently suspended surplus sign-up system don’t appear to be posted in any formal statement or communication from the county. Instead, they’re found in the county Facebook account’s responses to users’ comments underneath the post first announcing it.

The notification alerts are to be sent first-come, first-served based on the order of sign-ups, the county said in one social media comment.

El Dorado’s suspended system has at least the optics of turning vaccine distribution into something of a mad dash, and several users who saw the initial Facebook post commented on it expressing confusion and misinterpreting it to mean El Dorado had done away with the state-set priority phases entirely, which is not the case.

Surplus shots being administered with no explicit barriers related to age or priority phase status effectively trims the requirements down to: Can you get here in an hour?

When that hour actually falls differs between the county’s two vaccination clinics, but both fall in the afternoon. Hass said the 30-to-60 minute window comes near the end of business hours at each clinic. The one in Placerville operates weekdays and closes at 3:30 p.m., and the one in South Lake Tahoe currently runs Mondays, Thursdays and Fridays, and closes at 1 p.m.

Interested residents must have opted in and received a text alert to receive an excess shot; they cannot just show up to the clinic at the end of those business hours.

Another Facebook user asked: What about second doses? Both Pfizer and Moderna’s vaccines are two-dose regimens, intended to be taken three weeks or four weeks apart, respectively.

“Everyone who receives a first vax via this alert will be told when they need to receive their second dose,” the county wrote. “We have sufficient vaccine/vaccinators available and have every reason to believe we will in 3-4 weeks when the second dose is needed.”

The system is also open only to El Dorado County residents, and it’s free of charge to those who receive it, the county said in further comments.

The system also raises some questions about equity and fairness in the process. Is this not technically a form of line-cutting? Attaching a one-hour clock as a condition could skew surplus vaccinations in favor of those with more flexible work schedules. And the first-come, first-serve sign-up protocol appears to have been first announced on social media, disadvantaging those who are online less frequently or not at all.

Asked about these concerns, Hass maintained that El Dorado is following the phase system as outlined by the state, with the optimization list introduced “to ensure that all doses are used and no vaccine is wasted.”

She pointed to guidelines shared by state health officials on Jan. 7 that appear to allow the practice: “After focused and appropriate efforts to reach the individual groups currently prioritized, health departments and providers may offer doses promptly to people in lower priority groups when: Demand subsides in the current groups, or doses are about to expire according to labeling instructions.”

However, that California Department of Public Health memo isn’t explicitly clear as to whether offering doses to “people in lower priority groups” means giving it to all lower priority groups at once, as El Dorado is doing, or if counties are supposed to be proceeding in descending order down the subsequent phases and tiers.

California’s vaccine launch off to troubled start

California’s rollout is evolving constantly, changing by the day as new guidelines come in from state and federal health officials. Gov. Gavin Newsom on Wednesday introduced a major overhaul when he announced that adults ages 65 and up would be eligible to receive shots in the same priority group previously reserved for those 75 and older.

The most populous state in the U.S. at 40 million residents, California has been sent more than 3.2 million doses by the federal government but, according to the CDC, had administered fewer than 1 million of them as of a Thursday update.

Even accounting for holding recipients’ second dose in reserve — a practice both the incoming Biden administration and outgoing Trump administration recently signaled would be discontinued — that leaves more than 1 million doses unadministered.

State health chief Dr. Mark Ghaly acknowledged earlier this week that California’s emphasis on risk, exposure and equity in the distribution process “has led to some delays in getting vaccine out into our communities.” While most would agree the process needs to be sped up, the key question is how to accelerate without deepening inequities.

Many users expressing themselves in social media comments seemed mostly supportive of El Dorado County’s surplus sign-up system, though.

And with Wednesday’s announcement that 17,000 of the county’s roughly 200,000 residents had signed up in a little more than 48 hours, some were enthused by the high demand — especially due to concerns that rising vaccine skepticism in recent years will hamper the ability to reach herd immunity.

A smaller group expressed criticism.

“I’m over the age of 65 and immunocompromised and haven’t heard one word from the county or the state as to when we can expect to get vaccinated!” one user wrote Thursday morning. “This is a total and complete failure of our system.”