Moderna COVID-19 vaccine doses
(Gary Coronado / Los Angeles Times)
Vaccine Watch

The Blue Shield compromise: Company will supply vaccine, but Santa Cruz County will control distribution

After initial pushback over concerns of equitable distribution of vaccines, Santa Cruz County is joining nine other local health jurisdictions in signing a memorandum of understanding with the California Government Operations Agency to allow Blue Shield to oversee vaccine distribution. Here’s what that means.

After initially pushing back against any dealings with Blue Shield of California, primarily over concerns of equitable vaccine distribution, Santa Cruz County plans to sign a memorandum of understanding (MOU) with the California Government Operations Agency next week. That MOU would allow Blue Shield to oversee how vaccines are allocated to the county public health department, but the county would retain control over how those doses get distributed.

Santa Cruz County is joining eight other local health jurisdictions forging a similar path. The state expects more counties to sign MOUs in coming weeks.

Blue Shield, the state’s new third-party vaccine administrator, will workdirectly with multi-county health systems like Kaiser Permanente and Sutter Health, as well as federally qualified health clinics, to allocate their vaccines. The state’s original plan had been for counties to sign agreements directly with Blue Shield, allowing the company to control both vaccine allocation and distribution.

But local health jurisdictions, including Santa Cruz County, mounted strong opposition to this plan, and so far only one jurisdiction — Kern County — has signed with Blue Shield directly.

Equity concern

The problem, county Health Officer Dr. Gail Newel told Lookout, was “Blue Shield would not allow us to redistribute any of our vaccines at all.” That would preclude targeted efforts the county makes with partners like Sutter Health, OptumServe, Salud Para la Gente, and others to reach specific, high-risk populations.

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“The big concern was equity,” Newel said. “How are we going to reach the vulnerable populations that only the local government and local partners that we work with would know?”

This was a concern shared by many other counties, including Los Angeles. “We were really upset,” Newel said. “Blue Shield just doesn’t have the best history around addressing equity.”

After significant pushback, with Los Angeles County being the “big guns” in the negotiations, according to Newel, the state agreed that local health jurisdictions could instead sign an MOU with the California Government Operations Agency.

But this MOU still didn’t allow for redistribution of vaccines — until the Government Operations Agency put out a letter this week declaring that redistribution by local health jurisdictions, like the Santa Cruz Health Services Agency, will be allowed, subject to approval from the state.

The MOU for Santa Cruz County will go before the Board of Supervisors on Tuesday. Newel expects approval and then the county administrative officer will sign it.

Once the MOU is finalized, Santa Cruz County will onboard with Blue Shield starting March 29. Newel said she does not expect this to create significant changes in the county’s vaccination program.

Nearby Santa Clara County has said they will not sign the MOU. Santa Clara County Executive Jeff Smith told Lookout partner the Los Angeles Times that Santa Clara County remains opposed to the statewide system run by Blue Shield.

“Each county has different needs and different levels of investments in their delivery system,” he said. “One size doesn’t fit all and we won’t sign a (memorandum of understanding) that causes a deterioration of our vaccine delivery system or health delivery system.”

Why Blue Shield to begin with?

Newel said that according to state and Blue Shield authorities, the most important role of Blue Shield will be to manage data, which has become an urgent issue in California’s vaccine rollout.

“The federal government is not willing to up the allocations to the state of California in a way that California sees as appropriate, because our data in California shows we’re sitting on a stockpile of 4 million vaccines,” Newel said. In reality, “We’re not, and we all know that. But, for example, the state says that Santa Cruz has 8,000 vaccines sitting that we’re not using and don’t have plans for. But we know that’s not the case.”

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Newel attributed the discrepancy to lags in data reporting, which she says has to go through multiple systems, and is very slow, often requiring manual entry.

“Blue Shield has the data management skills and technology to be able to manage the data for when this vaccine arrives from the federal government to the state, and then to allocate that, distribute it, track it all, report back to the state, report back to the (federal government),” Newel said.

Government Operations Secretary Yolanda Richardson told lawmakers in a legislative hearing Thursday that the state expects it will be able to vaccinate every adult who wants a shot by the end of June, after President Joe Biden previously said the United States is working to produce enough doses for every adult by the end of May. In a press conference Friday, Gov. Gavin Newsom also said that vaccines should be available to all adults beginning May 1.

“We will be ready to get those vaccines into arms,” Richardson said. “We have built a statewide vaccine network with Blue Shield that will be capable of administering at least 4 million doses of vaccine per week. Just in the last seven days here in California, we have administered over 2 million doses.”

-Los Angeles Times contributing

Vaccine Watch

Lookout’s Vaccine Watch, the latest on vaccine distribution countywide, is among eight Lookout initiatives documenting all aspects of the pandemic. For more, go to our COVID 2021 section, sign up for COVID Text Alerts and our COVID PM newsletter here, and leave feedback and ask questions at the end of this story.