Commercialization of new COVID-19 vaccine creates access hurdles for low income residents [The Press Democrat]

Oct. 22—With the pandemic officially over, distribution of the newest COVID-19 vaccine is, for the most part, in the hands of health care's biggest players — hospital chains, large medical groups and retail pharmacies.

That's fine for Sonoma County's residents who have commercial health insurance. But local health care advocates say many low-income and minority residents are being left out of post-pandemic vaccine distribution.

"It's like we haven't — as a medical system — we haven't learned anything from the pandemic," said Dr. Jennifer Fish, a local family physician and health care advocate.

Fish, who helped start the HPEACE, or Health Professionals for Equality and Community Empowerment, and other local health care professionals say the end of the federal COVID-19 public health emergency, back in May, has resulted in a dramatic reduction in federal funds for the COVID-19 vaccine.

The federal government is no longer supplying the vaccine for free and health care centers must now tap into their own funds to buy it. That money can be reimbursed, but many community clinics don't have the funds on hand.

At a cost of anywhere from $100 to $150 a dose, health centers like Santa Rosa Community Health and West County Health Centers say they just can't afford it.

"We just don't have that kind of money to pay upfront," said Gaby Bernal Leroi, CEO of Santa Rosa Community Health, the largest consortium of community clinics in Sonoma County.

Bernal Leroi said even though demand for the COVID-19 vaccine is less than it was during the height of the pandemic, purchasing the needed doses would still require a huge investment.

"We serve 40,000 people, so even if we were to just want to vaccinate half of those people we would need 20,000 doses," she said. "It's about $150 a dose the last I heard, so that would be like $3 million to vaccinate half our population."

Meanwhile, Sonoma County health officials have stepped back from the aggressive role they played during the pandemic. With the federal and state public health emergency over, local health officials said they are no longer spearheading community vaccination clinics, such as the ones at Roseland Library in Santa Rosa and the Rohnert Park Community Center.

Most residents who receive medical care at a local community clinic are covered by Medi-Cal health insurance, California's version of the federal Medicaid program. That coverage is administered by Partnership HealthPlan, a nonprofit managed care plan that has 130,600 members in Sonoma County and 34,600 members in Napa County.

Health care advocates like Fish say many of these residents currently do not have access to the vaccine. What's more, federal COVID-19 vaccine funds for people without insurance, through programs like the Bridge Access Program, are extremely limited, she said.

"When we talk about equity, the issue is that No. 1, (the vaccine) shouldn't be commercialized," Fish said. "This should be public health, it should just be free to people."

Fish said disparities in the nation's health care landscape, which boiled over during the pandemic, are largely perpetuated by the commercialization of medical care.

"And because very few health systems — including public health, including in the county — looked ahead to put it into their budget, to have money available for vaccination efforts," she said.

No vaccine available

The new updated COVID-19 vaccine, which provides protection against the latest, most dominant strain of the COVID-19 virus, is now readily available for people with commercial health insurance. Kaiser Permanente and Sutter Health began offering vaccine to their patients earlier this month.

Kaiser Permanente, the county's largest primary care provider, serves about 27,500 people in Sonoma County who are covered by Medi-Cal. Kaiser said its members covered by Medi-Cal have access to the full range of Kaiser's health care services, including COVID-19 vaccinations.

Others are not so fortunate.

Mayra Arreguín, health care outreach worker with La Familia Sana, said the lack of vaccine has left many uninsured farm workers and undocumented immigrants with few options for getting inoculated with the updated vaccine.

"This affects our senior citizens and even farm workers who are on the older side who want to get vaccinated so they don't get sick and, in some cases, end up losing work," Arreguín said, speaking in Spanish.

Arreguín and Fish are among a number of local health care advocates and outreach workers who are calling on county officials to immediately address vaccine access hurdles. In an Oct. 16 letter to local health officials and county leaders, the outreach workers pointed out that not being able to access the COVID-19 vaccines through local community clinics is "inequitable and unjust."

"Our community clinics, which serve at least 29% of Sonoma County patients, desperately need help to provide these services," the letter said.

"Relying on pharmacies to provide vaccines is entirely inadequate and puts our communities at great risk," the letter said.

Nohemí Palomino, the president of the Roseland CBI y Equidad, which played a key role in pandemic outreach in southwest Santa Rosa, said county health staff have informed them that they don't have the funds to host vaccination clinics.

"We're asking that the county maintain funds in its budget and work with local health centers to ensure equitable distribution of the vaccine," Palomino said, speaking in Spanish.

Gabriel Kaplan, director of the Sonoma County Public Health Division, said that the "endemic phase" of the COVID pandemic led federal and state governments to shift most responsibilities for vaccine administration to the health care sector. He said health care providers and insurance companies inherited the task of managing the logistics and costs of vaccine administration.

"We are seeing challenges around manufacture, supply, supply chains, and a potential mismatch between the costs of the new formulations of the vaccine and what private and public payers are willing to pay," Kaplan said in an email.

"This is creating further problems in getting vaccines into arms," he said.

The Medi-Cal dilemma

According to Partnership HealthPlan spokesman Dustin Lyda, the State Department of Health Services has "carved out" the COVID-19 vaccine from Medi-Cal's managed care plans like Partnership HealthPlan. Health care providers such as community clinics will now be reimbursed from the state Medi-Cal Fee-for-Service delivery system, Lyda said.

That means that community clinics must buy their own supply of vaccine in advance and wait for payment later, said Pedro Toledo, administrative officer at Petaluma Health Center, which operates a number of clinics in Sonoma County, including large facilities in Petaluma and Rohnert Park.

Toledo said his organization has budgeted about $80,000 a month for COVID-19 vaccine going forward, and started planning for that months ago as it became clear that the federal government would no longer cover the cost of the vaccine.

Toledo added that the COVID vaccine is more expensive than the flu vaccine, about twice the cost, and purchasing doses now that it is only available commercially can be a huge financial burden, especially for health centers that are strapped for cash.

Fish acknowledged that there is currently limited access to the vaccine for everyone, even those with insurance. But she said those who bore the brunt of the COVID-19 pandemic are still being left behind.

"The impact of the consequences of that falls much more on low-income essential workers, communities of color, folks who don't have insurance," she said. "Basically, it's all of the marginalized groups for whom we have all the data, for years and years and years, that they're the most impacted."

While there's lack of access everywhere, the impact of that is going to be much more severe than those communities.

Fish said she was heartened to hear that Petaluma Health Center had "footed $80,000 to vaccinate their people. That's what equity is about."

"I don't blame the health centers," she added. "The blame doesn't land on any one entity. They're working really hard to try to figure this out and because there's no funding set aside at any of the levels, it's not happening."

Vaccine clinics in Napa County

Pandemic-era, community vaccination clinics are no longer taking place in Sonoma County. But over in Napa County, they are.

Dr. Christine Wu, Napa County's public health officer, said that back in the summer Napa County started planning for the eventual "commercialization" of the vaccine. Wu said the county took advantage of the federal Bridge Access Program, which provides no-cost COVID-19 vaccines to adults without health insurance and adults whose insurance does not cover all COVID-19 vaccine costs.

"We were tracking what the end of the pandemic emergency really meant and were trying to figure out what does commercialization mean and how do we ensure that our community stays protected," Wu said.

Wu said vaccines obtained through the Bridge Access program are being made available to eligible residents at vaccination clinics scheduled through this month and in November.

Kaplan, Sonoma County's public health director, said his division is also distributing COVID-19 vaccine obtained through the Bridge Access program, about 3,000 doses, to Sonoma County health centers.

Kaplan said the county is not allowed to use any of its remaining COVID-19 funds to address these vaccine distribution challenges and procure vaccines and contract with entities that are currently administering the vaccine.

"We share the frustrations of many in the public with the pace of this roll-out but we do not have the resources or means to become deeply involved in this challenge," he said in his email.

To cover gaps created by the commercialization of COVID-19 vaccines, health care providers can also obtain doses for their youngest patients through the federal Vaccines for Children program. Again, supplies are limited, said Bernal Leroi, CEO of Santa Rosa Community Health.

"We have received 170 pediatric doses. We care for approximately 13,000 children," she said in an email. "We've received 100 doses for uninsured patients only. We serve approximately 5,500 uninsured patients."

You can reach Staff Writer Martin Espinoza at 707-521-5213 or [email protected]. On Twitter @pressreno.

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