California is preparing to receive its first batch of the COVID-19 vaccine in the coming days – 327,000 doses shipped directly from Pfizer to pre-selected vaccine distribution sites across the state.

Although nursing homes and the state’s frontline health care workers have been placed at the front of the line, it’s still a very long line. There are 2.4 million healthcare workers and thousands of assisted living facilities in California, so there is growing concern about whether the most vulnerable populations will, in fact, be the first to receive the vaccine, as health officials intend.

“That is millions and millions of people when you only have a few hundred thousand doses of vaccine,” said Governor Gavin Newsom at a press conference earlier this month.

The Governor said state officials would be aggressive in ensuring those with money, influence, or connections won’t be able to cut to the front of the line.

“Those that think they can get ahead of the line and those that think because they have resources or they have relationships that will allow them to do it, we will be monitoring that very, very closely,” Newsom said. “We will prioritize, and we will expect that everyone in the healthcare delivery system is held to the same ethical standard, prioritizing those that are truly in need.”

While the wealthy and influential did have better access to COVID-19 testing, health experts say skipping to the front of the vaccine line will be far more difficult.

“With testing, you can go out and buy a test kit, even go to an urgent care center or laboratory,” said Dr. Eric Toner, a senior scholar with the Johns Hopkins Center for Health Security. “But, here, the vaccine is owned by the government and it’s tightly controlled. So, I think it’ll be harder to do that. Nothing’s impossible, but I think it would be harder.”

Toner, however, said getting the vaccine to 300 million Americans is an unprecedented logistical challenge, and he worries about vaccine access in the country’s marginalized communities.

“Mostly, I’m worried about our ability to get to those places that we really think it is most important,” Toner said. “That is communities that have historically been marginalized or disenfranchised that distrust both government and people in the medical field.”

Each of California’s 58 counties were required to submit their own vaccine distribution plan to the state earlier this month, answering a standard set of questions, including how county health officials would reach those marginalized communities, and how they would keep the vaccine secure.

Most Bay Area counties, such as Santa Clara, said they will perform random audits to ensure storage and inventory requirements are being followed at points of distribution for the vaccine.

“[The Public Health Department] will complete random audits by calling or emailing the provider to check in on their procedures, and conduct site visits, as necessary,” Santa Clara County health officials wrote in their vaccine plan. “If the provider continues to not meet requirements, they may not receive allocations until corrective action is in place.”

NBC Bay Area checked in with several large hospital chains in the region to ask about their plans to secure the vaccine once they get it, but all declined to discuss specific details. Most hospitals have increased their general security since the onset of the pandemic to enforce admittance restrictions.

Many hospitals and health care facilities will be responsible for vaccinating their own staff, and front-line health care workers like UCSF’s Dr. Armond Esmaili will be among the first to receive a dose.

Over the past nine months, Esmaili has treated dozens of patients suffering from COVID-19 and said he has medical colleagues across the country who have become infected as well.

“It strikes a chord when you see someone who’s pouring 80, 90 hours into the week, their heart and soul,” Esmaili said. “Not seeing loved ones, not seeing family – to see them get ill, it’s really hard.”

Esmaili said getting vaccinated isn’t just about his safety. It will also limit the exposure of the most vulnerable who continue to be admitted to the hospital, giving him peace of mind while he and his colleagues continue to treat the sick and dying.

“Many of us feel like this is what we were made for,” Esmaili said. “This is what we’ve trained our whole careers to do and this is where we rise to the occasion to meet the needs of our patients.”

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By Arlene Huff

Arlene Huff is the founding member of Golden State Online. Before that She was a general assignment reporter. A native Californian, she graduated from the University of California with a degree in medical anthropology and global health. She currently lives in Los Angeles.

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