January 28, 2021

Governor Newsom’s new plan to centralize COVID-19 vaccine allocations and data moved forward with the selection of Blue Shield of California to serve as the third party administrator (TPA) for the new framework.

Announced by Secretary of Health and Human Services Dr. Mark Ghaly on Tuesday, the state’s new plan to expedite vaccinations inserts the TPA as the solution to inaccurate data and patchy vaccine distribution. Under the proposal – which is not available in written form – the TPA would shoulder the responsibility for determining which providers may administer vaccines and distributing available doses to those providers. The TPA would also enforce and incentivize more timely data capture from providers and focus on efficiency – that is, getting shots into arms – above all else.

The insertion of a new entity into the vaccination process, in the face of months of planning and resource marshalling by counties and six weeks after the first vaccines became available, threatens to divert gains made by counties and the critical work of serving underserved and marginalized populations.

Counties are grappling with many aspects of the Governor’s plan, including:

• Allocations: Will vaccine allocations be modified by the TPA, and what any changes be based upon? Currently, local health jurisdictions are allocated about 80 percent of the state’s doses, while large multi-county health entities receive about 20 percent.
• Input and Collaboration: County input, both initially and ongoing, must be a core commitment within this new framework. Local health jurisdictions (58 counties and three cities) possess expertise on special populations, effective logistic experience for vaccination events both large and small, specialized outreach strategies, and granular knowledge of the local provider landscape. Any effort moving forward that deprioritizes or disregards county input will surely fail to effectively vaccinate all Californians.
• Equity: Counties are the only entity tasked with protecting the public health of ALL residents within our boundaries. Local health jurisdictions partner with local providers, clinics, schools, churches, and other cultural institutions to carry out this responsibility. Efforts to streamline and centralize vaccinations must not simultaneously exacerbate health inequities.
• Resources. Counties are in immediate need of cash resources to continue pushing out vaccines to our communities. Rapid, flexible, up-front funding is required regardless of the proposed new framework, as counties will continue to play a lead role in inoculating California and reopening our economy and schools.  Further, counties have already applied considerable resources to obtain and staff vaccination sites, develop online reservation systems, and mount both broad and targeted public affairs campaigns to increase vaccination rates. Any migration to a new vaccine framework, including the statewide rollout of the online MyTurn system, risks marginalizing at best, and wasting at worst, these publicly funded activities. 

Obviously there are many details and questions to address. CSAC is working around the clock to connect our leadership– the Executive Committee, Kitchen Cabinet and Rural Counties Working Group–directly with the Administration to obtain clarity and additional information so that elected county leaders can do what they do best: lead during times of crisis.