Monday, December 17, 2018
[San Diego County] Roberts Walks Back His Suggestion the County Didn’t Have Enough Hep A Vaccines
Blog note: this article references a grand jury report.
Outgoing Supervisor Ron Roberts is backing away from comments he made earlier this week suggesting the county delayed declaring a public health emergency over last year’s deadly hepatitis A outbreak because it didn’t have enough vaccines.
Last September, nearly six months into a deadly hepatitis A outbreak that by then had left 15 dead and sickened hundreds, county officials formally declared a health crisis. That move came after months of sluggish responses.
County officials have not elaborated on why they waited to make the declaration – other than to say that its most crucial benefit was increased public awareness.
Roberts, who represents the district that spans much of the city of San Diego and who is set to leave office in the coming weeks, offered a new explanation for the delay this week in an exit interview with KPBS.
“There were people that said, ‘Well, you didn’t declare (a) health emergency soon enough.’ And nobody understands the real crisis was we didn’t have access to vaccine,” Roberts told KPBS. “And we were worried that if the general public stampeded to get vaccine, we weren’t going to be able to have vaccine for the people that were on the street.”
Roberts said the county had worked “feverishly” behind the scenes with local hospitals and federal officials and scrambled to buy tens of thousands of doses of the hepatitis A vaccine.
“But we were really afraid if it became a community-wide panic, that we were going to be in real trouble,” Roberts went on. “And that’s why there was a little deferring in terms of declaring the public health crisis.”
In the months before the public health declaration, health officials often emphasized that only at-risk groups – homeless San Diegans, drug users and a few other groups – needed hepatitis A vaccinations, and they never spoke publicly about a shortage.
They also never publicly discussed their limited resources until the weeks after the public health declaration, so Roberts’ comments raised new questions about challenges county leaders may have faced in the early months of the health crisis.
Roberts’ spokesman Tim McClain sought to clarify the supervisor’s remarks to KPBS after inquiries from VOSD.
McClain said Roberts’ comments about the delay in issuing the emergency declaration were based on his own interpretation of the situation – and that that there was never a shortage of vaccines for homeless San Diegans and illicit drug users who were disproportionately battered by the outbreak.
Roberts had simply worried there could be a shortage and was reticent to take steps that might have jeopardized the supply of vaccines for those most at risk, McClain wrote in an email to VOSD.
“That is his personal view, but it was based on information he was receiving in one of his many briefings on this fast-moving situation for which no playbook existed,” McClain said. “(Roberts) did not direct how the health professionals responded. He was confident in, and remains proud of, the response by the county’s health team.”
County spokesman Mike Workman also said the county maintained an adequate supply of hepatitis A vaccines throughout the outbreak.
“There was no shortage of vaccine for the targeted high-risk population,” Workman wrote in an email to VOSD.
But county health officials have reported that more than 150 people who weren’t homeless or illicit drug users also fell ill.
The county has previously argued that declaring a health emergency before September 2017 may have affected the supply of vaccines for those most at risk in the outbreak’s early months.
“Declaring earlier could have diverted vaccine and nursing resources away from the critical at-risk population at the onset and hampered the urgent ability to reach the targeted population,” county officials wrote in a response to a blistering county grand jury report that concluded the county should have made the declaration sooner.
Yet the county didn’t directly claim it put off declaring the emergency for this reason.
The county did say in its formal response to the grand jury that the county had followed federal Centers of Disease Control and Prevention officials’ direction to focus on mass vaccinations to stem the outbreak.
The increased public awareness following the emergency declaration led to an explosion of interest in vaccines, which the county said led it to separately order 41,250 more hepatitis A vaccines than it could get from government sources to ensure it had enough.
Mayor Kevin Faulconer urged the county to declare a public health emergency in the aftermath of a VOSD story that documented bureaucratic fumbling as the outbreak worsened.
“If the county declares a state of emergency, the region could receive state and federal funding to address the hepatitis A outbreak,” Faulconer’s office wrote in a Sept. 1, 2017, press release. “Additional funding could go to a variety of programs that could curb the spread of the virus.”
The county declared the public health emergency hours later.
Workman, the county spokesman, did not respond to VOSD’s questions about whether there had been discussions about declaring a public health emergency prior to the mayor’s request – or why the county may have decided against it before that.
Supervisor Greg Cox told VOSD last year that county officials had asked state authorities about the potential impact of an emergency declaration months before they finally did so, and learned it wouldn’t result in more resources for the county. So, they decided to focus on other responses.
“The ultimate declaration of the public health emergency was issued to alert the public of the seriousness of the health threat among high-risk populations,” Cox wrote in a statement to VOSD last September.
In their May after-action report, county officials acknowledged the emergency declaration helped pave the way for street cleaning and homeless camp clean-ups that followed in cities across the county.
Before the declaration, the county had struggled to coordinate with city officials to ramp up those efforts.
San Diegans may learn more about discussions surrounding the emergency declaration next week.
The state auditor’s office is scheduled to release its analysis of local governments’ response to the outbreak next Thursday. The office has said its review would cover the county’s efforts prior to the emergency declaration and the criteria it used to make that call.
December 14, 2018
Voice of San Diego
By Lisa Halverstadt