Santa Clara County has provided excess vaccine doses to a top government official and dozens of other non-health practitioners over the past month, raising new questions about healthcare providers’ discretion to vaccinate lower-priority people amid a chaotic nationwide rollout.
While Santa Clara County is not the only provider to face the problem, its choices are in part raising eyebrows as the county has at the same time taken a tough stance against other providers who deviate from normal protocols, recently discontinuing vaccine for Good Samaritan Hospital because it has improperly vaccinated teachers in Los Gatos.
Since Jan. 11, the county has relied on a written plan explaining what to do with excess vaccine, which should be used immediately once it starts to thaw. It calls for first offering the vaccine to those in Phase 1A, the highest priority, followed by those 75 and older, and then transporting vaccines to the Valley Specialty Center at VMC or Saint Louise Regional Hospital.
While counties across the state struggle to ethically manage additional daily doses in the context of a general shortage, the protocol seems to leave room for what happens next. At least twice, rapid thawing vaccines have landed in the arms of county employees considered part of Phase 1B, including County Counsel James Williams and others who do not regularly come face to face with coronavirus patients. Some of these workers, including Williams, are also much younger than those now prioritized on vaccination.
The largest group was vaccinated on Dec. 30, nearly two weeks before the county issued written rules for additional doses, when County Executive Jeff Smith authorized about 45 county employees working in the county’s emergency processing center to receive vaccines that, according to the county were otherwise heading for the garbage.
State guidelines prioritize health workers and those living in long-term care facilities in Phase 1A, followed by those over the age of 65, educators, food and agricultural workers, and relief workers in Phase 1B, which includes the EOC staff.
“These are by definition slots that are not known in advance. These are not agreements – what was unique one day was that it was a much larger number, ”said Williams, who is in his late thirties. “We’re usually talking about onesies, twosies or maybe a dozen.”
At 4 p.m. on December 30, Smith said he received a call that the Valley Medical Center employee health center had a batch of unused Pfizer doses and no higher-priority health workers in the area who needed it. With approximately 90 minutes remaining to administer the doses, Smith allowed those physically present at San Jose emergency operations headquarters – including Williams, administrative staff, analysts, and other support personnel – to receive their first doses that afternoon. Williams said he was one of the “very last people in line.”
At the time, about 6,000 health and support workers had been vaccinated across the district.
“There was no available group of people in the hospital, so emergency response staff seemed reasonable,” said Smith. “My thought was, ‘Well, if doctors, nurses and technologists aren’t available, then we have to go to the emergency services.” “
The state’s vaccination guidelines from December give providers some discretion in lowering the priority list when vaccines are about to expire or people don’t show up for appointments. Health departments may “temporarily adjust the prioritization” only after “intense and appropriate efforts to reach the groups that have priority at the time,” said the California Department of Public Health, which did not respond to a request for comment on Friday.
But exactly how those scenarios play out in reality has created both confusion and heated discussions. Last week, the province sanctioned Good Samaritan Hospital for offering surplus vaccines to teachers – including among the Phase 1B group. The county claimed the hospital’s actions included a “problematic” series of events in which teachers were offered vaccines on future dates, not just surplus vaccines.
County employees in Phase 1B only received vaccines on the day they became available and only kept other options, Smith and Williams said.
In another case on Jan. 12, Deputy Director of Emergency Management David Flamm warned emergency response personnel, public health field personnel, and other 1B workers for a registration link to sign up for same-day appointments “approved by district leadership” , according to e-mail obtained by this news organization.
Flamm said Friday was the only time he was asked to send such an email, and the vaccines were found to be available in multiple locations. “DO NOT FORWARD !!!!!” the email told recipients, adding, “If you cannot get vaccinated today, we expect there will be additional days in the next few weeks when this possibility could arise.”
“With all the vaccination surgeries going on, it seems to me that there is always a difference between the number administered and cancellations, or some other number of issues, so I just expected this to happen again,” said Flamm.
In all, there are “at least a few” cases of 1B workers who received vaccines in addition to the Dec. 30 group, but by far fewer numbers, Smith said.
“We found ourselves in a situation where we have a scarcity of vaccines, a challenge with interpreting state rules, a lot of people who would want the vaccine – and we tried, and still have tried, to focus initially on health care professionals and counselors, “said Smith.” It’s a use or lose the situation. “