Wednesday: The state’s vaccine system continues to be fraught with problems. Here’s what to know.

By Jill Cowan

Good morning.

As virus cases and hospitalizations drop and increasing attention turns to the state’s vaccine rollout, California officials are attempting a fine balancing act between speeding up the process and ensuring that vulnerable populations aren’t shut out.

On Tuesday, Dr. Mark Ghaly, the state’s secretary of health and human services, said in a news conference that the two goals were not mutually exclusive.

“This notion that we have to make a choice between speed and equity — it’s a false choice,” he said. “We can do both.”

[Track coronavirus cases, deaths and hospitalizations in California.]

But in a state where officials have repeatedly said that equity was a top priority, and that transparency would be built into the effort, information about who’s getting vaccinated and in what order has been difficult to come by.

So far, more than 3.5 million doses of vaccine have been administered in California, Dr. Ghaly said. The rate of vaccinations statewide, he said, has been building day by day, since a surge in hospitalizations over the holidays. According to a New York Times tracker, about 7.4 percent of the state’s population has gotten at least one shot. That number is 8 percent for the nation overall.

However, the state has not released demographic statistics about who received the vaccines, so it’s unclear whether Latinos or other Californians of color who have been at disproportionate risk have been vaccinated at commensurate rates.

[Read about how wealthier white people are going to poorer neighborhoods to get vaccines.]

Dr. Ghaly suggested state officials were weighing several methods of incentivizing vaccine providers to specifically target vulnerable communities, including with payments for performance.

Gov. Gavin Newsom last week announced that the state would revamp its vaccine distribution approach after widespread criticism that the rollout had been confusing and piecemeal.

Part of that restructuring involved enlisting two of the state’s biggest health insurers, Blue Shield of California and Kaiser Permanente, to help with a statewide distribution system that would prioritize equity and streamline a patchwork system.

And the state created a website and data portal that officials have said will not only notify Californians when they are eligible for a vaccine and help them make appointments, but also would help collect and share data with federal agencies or others who may be working to allocate vaccines.

[Visit the site, myturn.ca.gov, to sign up for notifications.]

On Tuesday, Dr. Ghaly declined to share details of the partnerships, but said any transitions to new systems would not disrupt existing appointments.

Experts have said that enlisting bigger, more experienced health care providers could help accelerate a vaccine rollout that has been hampered by its being implemented by already overwhelmed local public health departments.

In at least one place, though, simply having a smaller, more nimble agency in charge has made a significant difference, officials there have said.

A Look at Long Beach

Mayor Robert Garcia of Long Beach told me that the fact that the city has its own health department, separate from Los Angeles County’s, had helped make its vaccine rollout a model within the state, hailed by Mr. Newsom.

“We can move fast and make decisions quickly,” Mr. Garcia said. “It’s been very beneficial.”

The city of about 467,000 people — Los Angeles County’s second largest — was the first jurisdiction to move from vaccinating health care workers and nursing home staff and residents to inoculating grocery store workers and critical public schoolteachers and staff. Anyone 65 and older has also been eligible, as directed by the state.

And it is also set to begin vaccinating crucial workers at California State University, Long Beach.

[See how the vaccine rollout is going in California and other states.]

As of Tuesday, some 48,000 doses had been administered, according to data provided by Jennifer Rice Epstein, a city spokeswoman. The city has also been inoculating nonresidents who work in Long Beach, but if the doses had all gone to residents, that would represent more than 10 percent of the population.

That includes shots for 16,000 health care workers, almost 7,000 long-term care facility residents and staff, and 2,500 grocery store workers.

Mr. Garcia said the city’s health department was able to build on significant work bringing testing to harder-hit neighborhoods, where many lower-wage, often undocumented workers live.

[Read more about what a map of Los Angeles County’s unequal Covid-19 surge tells us.]

“We had one of the best testing operations of anywhere in the state,” he said. “A lot of our testing sites just became vaccine sites.”

Those efforts have been coupled with a robust notification system that frequently updates users, even if they are not yet eligible for a vaccine, he said.

Covid-19 Vaccines ›

Answers to Your Vaccine Questions

Currently more than 150 million people — almost half the population — are eligible to be vaccinated. But each state makes the final decision about who goes first. The nation’s 21 million health care workers and three million residents of long-term care facilities were the first to qualify. In mid-January, federal officials urged all states to open up eligibility to everyone 65 and older and to adults of any age with medical conditions that put them at high risk of becoming seriously ill or dying from Covid-19. Adults in the general population are at the back of the line. If federal and state health officials can clear up bottlenecks in vaccine distribution, everyone 16 and older will become eligible as early as this spring or early summer. The vaccine hasn’t been approved in children, although studies are underway. It may be months before a vaccine is available for anyone under the age of 16. Go to your state health website for up-to-date information on vaccination policies in your area

You should not have to pay anything out of pocket to get the vaccine, although you will be asked for insurance information. If you don’t have insurance, you should still be given the vaccine at no charge. Congress passed legislation this spring that bars insurers from applying any cost sharing, such as a co-payment or deductible. It layered on additional protections barring pharmacies, doctors and hospitals from billing patients, including those who are uninsured. Even so, health experts do worry that patients might stumble into loopholes that leave them vulnerable to surprise bills. This could happen to those who are charged a doctor visit fee along with their vaccine, or Americans who have certain types of health coverage that do not fall under the new rules. If you get your vaccine from a doctor’s office or urgent care clinic, talk to them about potential hidden charges. To be sure you won’t get a surprise bill, the best bet is to get your vaccine at a health department vaccination site or a local pharmacy once the shots become more widely available.

Probably not. The answer depends on a number of factors, including the supply in your area at the time you’re vaccinated. Check your state health department website for more information about the vaccines available in your state. The Pfizer and Moderna vaccines are the only two vaccines currently approved, although a third vaccine from Johnson & Johnson is on the way.

That is to be determined. It’s possible that Covid-19 vaccinations will become an annual event, just like the flu shot. Or it may be that the benefits of the vaccine last longer than a year. We have to wait to see how durable the protection from the vaccines is. To determine this, researchers are going to be tracking vaccinated people to look for “breakthrough cases” — those people who get sick with Covid-19 despite vaccination. That is a sign of weakening protection and will give researchers clues about how long the vaccine lasts. They will also be monitoring levels of antibodies and T cells in the blood of vaccinated people to determine whether and when a booster shot might be needed. It’s conceivable that people may need boosters every few months, once a year or only every few years. It’s just a matter of waiting for the data.

Employers do have the right to compel their workers to be vaccinated once a vaccine is formally approved. Many hospital systems, for example, require annual flu shots. But employees can seek exemptions based on medical reasons or religious beliefs. In such cases, employers are supposed to provide a “reasonable accommodation” — with a coronavirus vaccine, for example, a worker might be allowed to work if they wear a mask, or to work from home.

If you have other questions about the coronavirus vaccine, please read our full F.A.Q.

The city data showed that about 49 percent of the people who have been vaccinated in Long Beach are white — a reflection of most of the vaccines having gone to residents 65 and older, a population that is mostly white, Ms. Epstein wrote in an email. Roughly 21 percent were Hispanic or Latino, about 20 percent Asian and 7.6 percent Black or African-American.

The city’s population is nearly 45 percent Hispanic or Latino, and roughly 28 percent white, 12 percent Asian and 11 percent Black, according to data from the U.S. Census Bureau.

Still, it’s tough to get a sense of how this compares with other jurisdictions or the state more broadly in the absence of more detailed data. But the numbers suggest that it will be challenging to fast-track vaccinations to specific at-risk groups.

In any case, Mr. Garcia said he believed that the statewide partnerships with insurers could help streamline vaccine distribution even more, in particular the allocation of doses to providers — whether they are public health departments or clinics.

“There needs to be a change,” he said. “I’m very hopeful this new system will fix some of the issues.”

(This article is part of the California Today newsletter. Sign up to get it delivered to your inbox.)

Read more:

“We’re building the airplane while we’re flying.” Did banning outdoor dining help curb Los Angeles’s virus surge? It didn’t hurt, epidemiologists say, and officials needed to try everything. [The Los Angeles Times]

The state’s vaccination campaign is set to begin prioritizing people by broad age categories starting in February. That has angered disability advocates, who say that it ignores those with medical conditions that put them at higher risk if they contract the coronavirus. [The San Francisco Chronicle]

San Jose and Oakland may require grocery stores to compensate workers with additional “hazard pay.” [The Mercury News]

If you missed it, Kroger, which owns several supermarket chains including Ralphs, said it would close two stores in Long Beach after the city imposed a similar ordinance, requiring an extra $4 an hour for workers during the pandemic. [The Los Angeles Times]

And Finally …

There were not so many hoorays for “Hollyboob.” (I’ll see myself out.) Six people were arrested for this.

California Today goes live at 6:30 a.m. Pacific time weekdays. Tell us what you want to see: [email protected]. Were you forwarded this email? Sign up for California Today here and read every edition online here.

Jill Cowan grew up in Orange County, graduated from U.C. Berkeley and has reported all over the state, including the Bay Area, Bakersfield and Los Angeles — but she always wants to see more. Follow along here or on Twitter.

California Today is edited by Julie Bloom, who grew up in Los Angeles and graduated from U.C. Berkeley.

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