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California plans dramatic push of COVID-19 booster shots, vaccinations

A person gets a COVID-19 shot.
The L.A. County Department of Health Services Housing for Health division hosts a COVID-19 vaccination clinic for residents experiencing homelessness.
(Jason Armond / Los Angeles Times)

With millions of Californians slated to be eligible for a COVID-19 vaccine booster, the state is planning to dramatically ramp up its inoculation rate.

Officials unveiled a new COVID-19 Vaccine Action Plan on Thursday — just hours before the director of the U.S. Centers for Disease Control and Prevention, Dr. Rochelle Walensky, said a third Pfizer-BioNTech dose should be given to those 65 and older, residents in long-term care settings, and those age 50 to 64 with underlying medical conditions at least six months after receiving their initial series of vaccinations.

The CDC also said younger adults with underlying medical conditions may get a booster, as well as adults age 18 to 64 at increased risk for exposure to the coronavirus because of occupational or institutional settings.

The CDC recommendations, issued after midnight Friday morning Eastern time, only apply to people who received the Pfizer vaccine. “We will address, with the same sense of urgency, recommendations for the Moderna and J&J vaccines as soon as those data are available,” Walensky said in a statement.

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While more recommendations from state officials are necessary before a third dose is distributed widely to people in those categories, officials say they’re preparing now to make sure they’re ready.

“We are working hard to make sure not only are we prepared to provide it, but those who are eligible know that they’re eligible and know when the time is right,” California Health and Human Services Secretary Dr. Mark Ghaly said during a briefing.

Officials say the state’s MyTurn platform will have the ability to screen residents’ booster eligibility, as well as send text messages to alert people of available options.

The U.S. has moved a step closer to offering booster doses of Pfizer’s COVID-19 vaccine to seniors and others at high risk from the virus.

State officials estimate there are about 6.6 million seniors who eventually could be eligible for a booster dose, and Ghaly said many in this group were recipients of a Pfizer-BioNTech shot. Younger Californians could add their names to the queue depending on how high-risk conditions are ultimately defined.

Moving expeditiously to cover these populations would entail dramatically accelerating the inoculation rate.

At the peak of the rollout in April, providers statewide were giving out a bit more than 400,000 daily doses on average. But over the last week, an average of only about 62,000 shots have gone into Californians’ arms per day, Times data show.

It’s been months since the state’s rolling average topped 100,000.

It is very easy to get vaccinated in California — there’s often no need for an appointment, and doses are plentiful at retail pharmacies, which have become a popular place to receive the shots.

Officials have already observed less intense demand than they had expected for third doses of the Pfizer and Moderna vaccines for certain immunocompromised people, which began to be distributed in mid-August. California officials, for instance, had expected the demand for third doses among that group to peak the week of Aug. 30, forecasting 114,000 doses to be administered that week, significantly more than the 75,000 doses that were given.

California officials estimate that about 259,000 third doses for the immunocompromised have been administered since mid-August. That’s only about one-third of the state’s population of people with moderately to severely compromised immune systems.

State officials say it’s possible that demand for the COVID-19 boosters could surge, especially if there’s a worse-than-expected autumn and winter outbreak. Already, Kaiser Permanente is planning for mass vaccination sites, as are other local health jurisdictions.

CDC decision rejects recommendation by advisors not to give extra doses of Pfizer’s COVID-19 vaccine to healthcare workers but follows the panel’s endorsement of boosters for older Americans.

Booster administration for those 65 and older will rely mostly on pharmacies and primary healthcare offices, while mass vaccination clinics may need to be reopened or expanded if eligibility is offered more broadly among younger adults. Pharmacies currently provide more than 60% of administered vaccine doses and can probably handle more demand, state officials say.

School-based vaccine clinics, pharmacies and pediatricians will likely be the primary sites for vaccinations for those younger than 12 when children become eligible for vaccination. The California Health and Human Services Agency says vaccinations for 5- to 11-year-olds might start by mid-October.

Officials say a slowdown in inoculations in recent months is partially the byproduct of a strong share of the population — about 66% — having already been at least partially vaccinated, leaving a pool predominantly full of people who have hesitated or resisted rolling up their sleeves.

Still, officials say there is existing infrastructure to ramp up vaccine distributions — though with the caveat that “this will require ongoing engagement of providers at every level to ensure they are ready, resourced and willing to operate at this capacity.”

Some local governments and healthcare providers are planning for the potential to reopen mass vaccination sites. Such clinics may also need additional staffing, which could be strained if hospitals treating COVID-19 patients are also facing an increased demand.

A Los Angeles Times analysis found that Inland Empire counties had higher hospitalization rates this summer than any other county in Southern California.

Mega-sites — such as those at sports stadiums, universities and theme parks — were a hallmark of the early inoculation campaign.

But as demand fell, providers pivoted away from huge, centralized operations in favor of a more community-based approach, bringing vaccines to where people live, work and recreate. A planned increase in vaccinations or booster shots also will bring a continued need to transport people to vaccine sites or bring doses to some in their homes.

“California continues to lead the nation in both vaccines administered and low case rates. Vaccines work. They are safe, effective and are how we end this pandemic,” Gov. Gavin Newsom said in a statement. “We fully support our federal partners’ determination to provide boosters, and California has built the necessary infrastructure to mobilize such vaccine distribution.”

The recent CDC recommendation is not the final step before boosters become commonplace.

The Delta variant is causing a surge in infections among children, but experts say it’s not causing more severe disease for young patients.

The Western States Scientific Safety Review Workgroup — which includes public health experts from California, Nevada, Oregon and Washington — will still need to weigh in, as will the California Department of Public Health.

“So all providers throughout California, including pharmacists at your local retailer, pharmacy or your health system — even the staff at all of our [points of distribution] — have to wait for the green light from” the state public health department, Dr. Regina Chinsio-Kwong, a deputy health officer for Orange County, said earlier this week.

Los Angeles County Public Health Director Barbara Ferrer said many vaccination sites will be prepared to increase daily vaccination capacity. Countywide, there’s capacity to provide roughly 130,000 doses per day through a robust network of some 1,300 permanent clinics and 400 mobile teams.

“Many of the sites have already told us that they have a lot of capacity to expand very quickly to meet demand,” Ferrer said during a briefing.

In Silicon Valley, Santa Clara County officials are preparing to help people sign up for appointments, focusing on the hardest-hit communities.

The number of people hospitalized with COVID-19 in Los Angeles County has dropped below 1,000 for the first time in two months, underscoring the region’s slow but steady progress in turning the tide of the latest coronavirus surge.

Offering boosters — as well as the eventual expansion of vaccine eligibility to children under 12 — will move the inoculation campaign into a new phase at a critical time.

While California has made significant overall strides in its battle against the highly infectious Delta variant of the coronavirus, some experts and officials remain concerned about a potential resurgence later this year.

Areas with lower overall vaccine coverage also remain especially exposed to outbreaks. Unvaccinated Californians are eight times more likely to be infected with the coronavirus, 13 times more likely to be hospitalized and 15 times more likely to die from the disease than their vaccinated counterparts, Ghaly said.

In 11 of California’s 58 counties, more than 70% of the population is at least partially vaccinated, according to data compiled by The Times. But 14 other counties have coverage rates below 50%.

Ensuring as many people as possible have the full benefit of vaccine protection will help break the cycle of surges the pandemic has wrought over the last year and a half, experts and officials say.

And even with the upcoming emphasis on boosters, Ghaly said, “we’ll continue the strong drumbeat to get your first shot and start the series and get fully vaccinated.”

The Associated Press contributed to this report.


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