Even as California prepares to extend vaccination eligibility to all residents 16 years and older on April 15, the state has managed to vaccinate only about half of its elderly population – the target audience 65 and over who are believed to be most susceptible to death and death serious illness in the EU is considered a pandemic.
Overall, according to the latest data from the Federal Centers for Disease Control and Prevention, nearly 56% of California seniors have received the full course of a covid vaccine. That’s about average when compared to other states – not nearly as high as in places like South Dakota, where nearly 74% of seniors are fully vaccinated, but also not that far behind Hawaii, which hit 44%. The data, current as of Tuesday, does not include seniors who received only the first dose of the Pfizer BioNTech or Moderna vaccine.
The general progress in California, however, hides huge differences in vaccination rates for seniors in the state’s 58 counties, which for the most part have their own vaccine rollouts with different approval rules and contact protocols. The discrepancies are particularly broken down by geographic region, with the state’s remote rural districts – generally conservative strongholds – struggling in some cases to deliver available doses, while the more populous – and generally left-wing – metropolitan areas often have far more demand than supply.
For example, in San Francisco Bay Area counties like Marin and Contra Costa, more than two-thirds of seniors are fully vaccinated. Meanwhile, rural counties like Tehama, Shasta, and Del Norte in the far north of the state, which includes some of California’s most dramatic and harsh areas, have only about a third of seniors fully vaccinated, according to CDC data.
“We definitely have one thing in common: We have a pretty high percentage of people who are reluctant to vaccinate. And that even affects the seniors, ”said Dr. Warren Rehwaldt, Del Norte County’s Health Officer, on counties in Northern California with relatively low vaccination rates. Del Norte, who is 62% white and who firmly voted for Donald Trump in the 2020 elections, vaccinated 36.6% of residents aged 65 and over.
The district with 28,000 inhabitants has a spotty Internet service, so that the health department is dependent on telephone appointments for its twice-weekly clinics, which can dispense 300 doses per day.
“I don’t think we’ve filled any of them completely, and they’re tapering,” said Rehwaldt. Often 100 or more appointment slots remain unused, even after the district has extended the authorization to 50 years and older. “We expected it, but we didn’t expect it anytime soon,” he said.
Every Thursday morning, Rehwaldt joins a local public radio broadcast to encourage people to get their recordings, and the department regularly broadcasts public service announcements. “But it’s a really big hurdle to overcome serious concerns about the vaccine itself,” said Rehwaldt.
When asked what resources could help increase vaccination rates, Rehwaldt said he would opt for a mobile van to drive to remote areas of his county. But moments later he sighed and said he wasn’t sure a van would help much after all. “What resources will overcome the hesitation? It’s not a resource problem, ”he said.
Shasta County, whose population is roughly 80% white and who voted for Trump in even greater numbers, is also struggling to reach those 65 and over. Only 36.6% of seniors are fully vaccinated. Kerri Schuette, public information officer, admitted that health workers had experienced some hesitation among residents, but said early supply issues were also hampering their efforts.
At the other end of the spectrum are counties like Marin, a largely suburban and affluent portion of the communities north of San Francisco, where 71.4% of seniors are fully vaccinated.
“There are a number of privileges that lead to easier access to vaccines that need recognition,” said Dr. Matt Willis, county health officer. Many seniors in the county have access to computers and cars, he said, and have been able to access vaccine appointments with relative ease.
Still, the county made an aggressive plan to vaccinate seniors even before the first doses arrived, he said. For example, instead of waiting for the federal government’s program to rely on pharmacies to vaccinate residents of long-term care facilities, the health department sent workers out as soon as it had vaccines.
Through mid-February, the county continued to focus strictly on seniors aged 75 and over, while other counties expanded to include younger age groups and a wide range of occupations. At one point, the county briefly expanded the eligibility for teachers, but withdrew only a week later when the doses ran low.
“We have shown that a dose offered to someone 75 years and older in Marin is 320 times more likely to save a life than a dose offered to someone under 50,” Willis said.
Contra Costa County, a more diverse area across San Francisco Bay, has done almost as well: 70.9% of seniors are fully vaccinated. Add those who received at least one dose and the numbers are far higher: 90% of people ages 65 to 74 and 97% of those over 75, according to the county’s vaccine tracker.
To reach out to vulnerable seniors, Dr. Ori Tzvieli, assistant health officer for Contra Costa, said the county worked with nonprofit groups to compile lists of nursing homes and low-income retirement homes, and then sent mobile clinics to each one. “For people who were literally attached to their homeland, we send someone in. Otherwise we have set up a station in the lobby or right in front of the door, ”he said.
The district also set up mobile clinics on farms and places of worship. There were special appointments for community health workers to register elderly residents directly. And instead of letting residents find their own appointment slots online, the department had forms fill out and then schedule appointments for them, prioritizing those living in low-income, high-sickness zip codes.
With a population of just over 1 million, Contra Costa can now vaccinate 100,000 people a week, Tzvieli said, and recently opened the eligibility to anyone over the age of 16. But inequalities also persist within the district. In Bay Point, a working-class Latino community, vaccination rates are still only half those of some wealthier communities, Tzvieli said.
Further south, in California’s agricultural Central Valley, Fresno County is somewhere in the middle for vaccination rates. Around 54% of those over 65 are fully vaccinated, just below the national average. Only more than half of the county’s residents are Latinos, many of them farm workers. And about a fifth of the population lives in poverty, which poses its own hurdles for a vaccination campaign.
“Poverty is physically and mentally immobile,” said Joe Prado, director of the Fresno District community health department. “For a wealthier population 3 to 5 miles away [to a vaccine clinic] Is simple; You get in the car and leave. But when you live in poverty that is a huge barrier. “
There are community bags that haven’t looked at the county’s health system, which means health officials encounter vaccine reluctance and suspicion, Prado added. “Our health literacy is nowhere near where it should be, and now there’s a problem with digital literacy too,” he said. “We’re trying to cope with all of this in the middle of a pandemic.”
By this point in the campaign, Prado said, most seniors who are concerned about the vaccine have received at least one starting dose: “The last 25% will be the most resource-intensive and hardest to reach.”
Dr. William Schaffner, an infectious disease specialist at Vanderbilt University, calls the public health phenomenon “low hanging fruit”. As the percentage of people vaccinated grows, he said, “We’ll have to work proportionally harder to keep improving these numbers because the eager beavers come first.” In rural areas from California to Tennessee, he added, supply is already exceeding demand.
To date, only more than 75% of seniors in the US have received at least one dose of vaccine, according to the CDC.
“You can watch this because the glass is half empty or half full,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, on a recent episode of his weekly podcast. That leaves more than 13 million seniors unprotected despite being at the highest risk of death. 8 out of 10 deaths from Covid reported in the US were in adults aged 65 and over.
According to Osterholm, it is crucial that states continue to make efforts to reach and vaccinate vulnerable seniors who live or are reluctant in their home country.
“When we say we’re going to open the eligibility to anyone aged 16 or 18, it seems like a win,” he said. “In many countries this is an admission of defeat.”
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