Demand for Vaccine Growing, Supply ‘Uncertain’

What a way for Sansum Clinic to celebrate its 100th anniversary year. 

With Governor Gavin Newsom’s announcement last Wednesday that COVID vaccines would now be distributed to everyone age 65 and older, phones at Sansum’s 22 clinics throughout Santa Barbara County started ringing off the hook. Sansum was still scrambling to figure out the logistics to begin vaccinating its 12,000 patients who are 75 and older. The soonest that could start, Sansum CEO Kurt Ransohoff reckoned, was January 20. As far as the 65-and-up cohort, Ransohoff stated, “Just because the governor says something’s available doesn’t make it so.” The availability of vaccines, Ransohoff stressed, was “very tenuous.”

All that Ransohoff said early this Monday afternoon. By early Tuesday morning, the situation for Sansum and Ransohoff had grown much more tenuous.

A large batch of 330,000 Moderna vaccines delivered to 287 sites throughout California has now become the subject of a potential recall because fewer than 10 patients inoculated against the COVID virus at one of those sites showed adverse allergic reactions within a 24-hour period. 

None of the 500 doses from this batch allotted to Sansum have been administered. But out of an “extreme abundance of caution,” all health entities receiving these doses have agreed to what’s described as a “temporary pause.” 

This pause has pushed back Sansum’s starting date for vaccinating the 75-and-up age bracket “by at least one week,” Ransohoff stated. As for vaccinating its 9,000 patients ages 65-74, he said, that’s a matter of supply and demand. And right now, Ransohoff cautioned, demand for the vaccine is growing dramatically while the supply is becoming “much more uncertain.”

Sansum will continue to provide vaccines in the meantime, but the “pause” will hamper Sansum’s ability to ramp up to meet the growing demand. To put this number in perspective, Sansum now administers 500-800 vaccines during its Saturday vaccination clinics held at its Las Pesetas Lane facility. Helping Sansum cope with this hiccup, County Public Health is providing 500 doses. 

The delay isn’t all bad, Ransohoff noted. “It is a sign that our safety systems work,” he said. “One single site has experienced a slight increase in reactions, and they stop everything with that lot. That is a good sign. It’s not good that the offset of that is a delay in administering vaccine, but it’s still a good thing.”

It was already problematic even without the Moderna safety scare. Ransohoff pointed out that Santa Barbara health providers first began vaccinating patients four weeks ago. That means patients vaccinated with Moderna are now scheduled to receive their second doses. 

Both the Moderna and Pfizer vaccines require a second dose as part of their licensing agreement with federal regulators. Without special dispensation from a higher public health authority, Ransohoff said, Sansum lacks the discretion to delay the administration of second doses, as is taking place in England. 

At this point, Ransohoff stated, Sansum is proceeding on the assumption that there’s no latitude concerning the second doses. (Last week, the Washington Post reported that the stockpile of vaccines had been significantly depleted because federal health authorities had already allowed the supply of second doses to be dipped into for first-time vaccines.) 

At the same time Sansum needs to administer the second doses, Ransohoff explained, it’s also facing an expansion in the size of eligible patients, courtesy of Governor Newsom. “The problem with the supply is that it’s getting less reliable,” he added. 

Ransohoff said Sansum has worked closely with County Public Health administrators and the local hospitals to make sure the vaccines are administered in an orderly fashion. He said Sansum patients can expect to receive emails or postcards notifying them when they can schedule an appointment. 

He expressed horror at the long lines in Florida of people thronging for vaccinations. “We’re not interested in some Darwinian COVID-relief plan here where the person who can last longest gets the vaccine,” he said. “That’s the survival of the fittest, not necessarily who needs it the most.” 

To date, Sansum has inoculated its own frontline health-care workers and about 500 health-care workers from other entities. He estimated about 75 percent agreed to be vaccinated. As for the others, he stated he found their reluctance “very challenging.” Because Moderna and Pfizer were licensed under emergency-use provisions, Sansum and other employers are barred from requiring vaccination as a job requirement. 

When asked what he hears from workers who declined vaccination, Ransohoff said, “I hear ‘I’m afraid,’ or ‘I want to see how it works out with others first,’ or some are in the early terms of their pregnancy and don’t want to risk it. It’s a lot of personal reasons.” About half the patients seen by Sansum’s hospitalists — doctors who treat patients in the hospitals — have COVID.

Administering COVID vaccines is nowhere as simple as giving flu shots. Patients have to be observed for a full 15 minutes after the shot’s administered to determine if there are any allergic reactions. This makes scheduling appointments more challenging. Older patients, he said, tend to show up earlier, which is problematic because space is constrained.

To get achieve maximum numbers, Sansum first used its Pesetas site after it had been emptied of other patients and care providers. Sansum started doing vaccinations on Saturdays. It’s been hoping to expand to Sundays as well, supplies allowing, and has opened 5:30-7 p.m. on weekdays. 

During weekend sessions, he estimated, 20-25 staff are required. During evening sessions, he said, Sansum can get by with fewer. On Saturdays, he said, Sansum can vaccinate 45-50 patients per hour.

The vaccine itself, Ransohoff stressed, is free. To date, health-care providers have not been allowed to seek compensation from insurance companies for the administrative costs. The cost of staffing registered nurses, he said, is not cheap. “It’s really pricey to do it,” he said. “But after 100 years, if we can’t help the community in the height of a pandemic like this, that would be pretty sad.”

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