COVID-19 vaccine distribution and advocacy updates

The rate by which dentists are receiving their COVID-19 vaccinations varies widely across the state, depending on county-level distribution. Below is an overview of California’s vaccine administration plan, what is known about local logistics for vaccinating dental team members and CDA’s ongoing advocacy efforts.

DCA permits dentists to administer COVID-19 vaccines

As a result of recent CDA advocacy efforts and in a move to address the state’s shortage of health care providers eligible to administer COVID-19 vaccines, the Department of Consumer Affairs approved a public health emergency waiver that will allow dentists to administer COVID-19 vaccines to people age 16 and over.

CDA continues to advocate for partnership with dentistry when establishing mass vaccination clinics and to ensure that dentists that begin administering the vaccine are vaccinated themselves first.

Dentists already have the ability to practice outside of their traditional scope of practice during declared states of emergency under the direction of government entities. The DCA waiver establishes the necessary training dentists must complete through the CDC that is specific to vaccine administration, contraindications and adverse reactions.

The required trainings, totaling three hours, are free and self-paced:

While the trainings do not currently count toward continuing education requirements, CDA is working with the Legislature to not only make the scope expansion permanent, but also to have the CDC courses retroactively count towards C.E. renewal requirements.

Vaccine distribution landscape

California is currently in the process of providing the first doses of the COVID-19 vaccine to individuals within Phase 1a. This phase includes 3 million people and is divided into three tiers, with dentists falling in Phase 1a Tier 3. The vaccination plan for Phase 1a, including all tiers therein, has been finalized and is not subject to change. The state anticipates receiving enough vaccines to give everyone in Phase 1a their first dose by the end of January.

Vaccine distribution plans are determined by each local health department, which are largely county-by-county, however there are a few jurisdictions that run on city lines including Berkeley, Long Beach and Pasadena. Local dental societies have delivered letters to all public health officers within their component region to determine logistical details including: what the vaccine distribution plan will look like, how dentists and team members will be contacted once the vaccine is available to them and where vaccination sites will be located. Dental societies with appropriate space have also offered their offices as a vaccine clinic location for dental staff in the area. Copies of those letters can be found here and here.

Responses to dental component inquiries among counties vary widely. Some have invited dental society representatives to serve on taskforces while others have provided boilerplate responses or nothing at all. CDA has created a tracker to record the status of each county and have been updating it on a near-daily basis as dental societies and members provide updates. CDA has also communicated with the governor’s office asking for its reinforcement of effective distribution and communication by counties. 

Factors that affect how soon dentists receive vaccines

Some dentists have already received their first vaccine dose while others live in local health jurisdictions that have not vaccinated individuals in Tiers 1 and 2 yet. There are several factors that determine how quickly a local health department can vaccinate individuals in Phase 1a, including:

• The number of vaccines allocated to each local health department. This is largely determined by the population of the region.
• The number of individuals in Tiers 1 and 2, including hospital systems and clinics. Additionally, vaccines are randomized throughout health systems to prevent entire teams from experiencing typical side effects that can last 2-3 days after the vaccination. 
• Technology and staffing of the local health department. The technology capabilities of the department will determine how easy it will be for jurisdictions to reach out to dentists and their team members and how to sign up for vaccine appointments. Additionally, many local health departments are experiencing high staff turnover, especially at the public health officer level, which can affect how quickly vaccine plans are finalized. 
• Size of the local health department region. This will determine how much logistical planning and resources will be required to set up vaccination clinics within the jurisdiction. If the region is small or has close relationships with local hospitals/clinics, vaccines will more likely be set up at a few locations. If the region is large, rural or highly populated, vaccine clinics will likely be spread out and will take longer to set up.
• How many providers are eligible/available locally to administer the vaccine. While California has an infrastructure that can easily vaccinate 20 million people within a span of three months for the flu vaccine each year, this is usually done through pharmacies and PCPs/health systems. As the state goes through each phase and tier, there will be increasingly more individuals to vaccinate without the appropriate health care provider infrastructure to administer doses at a reasonable rate. 

CDA advocacy efforts

• Elevating dentists to Phase 1a, Tier 2. While the overarching state vaccination plan has been finalized for Phase 1a, CDA is working with dental societies to advocate for dentists to be included in Phase 1a Tier 2 at the local health department level. Several dentists who work in Tier 1 or 2 settings, hospitals and clinics respectively, are getting vaccinated with their colleagues instead of waiting until Tier 3. 
• Increasing the number of eligible vaccine providers. CDA submitted a memo on Dec. 28 to DCA and the California Department of Public Health requesting that the state utilize the untapped expertise of several health care provider types, including dentists, to help with vaccine administration. This waiver was granted on Jan. 4. CDA is continuing to advocate for a permanent scope expansion in the Legislature and for the mandated CDC training to retroactively count towards CE requirements for licensees.
• Streamlined administrative processes for vaccine registration. CDA  helped deliver a proposal by Henry Schein to CDPH and the Governor’s Office in mid-December to serve as the central administrator for the registration and coordination of tracking callbacks to patients needing second doses for private practitioners and providers new to administering vaccines, such as dentists, who do not have health system administrators providing that support already.
• Determining local health jurisdiction logistics. CDA is working closely with the state oral health director to conduct additional outreach to local health departments that have been unresponsive to dental societies. CDA is looking closely at successful local health departments that are already vaccinating dentists, such as Berkeley, to determine how their processes can be duplicated elsewhere. 
• Dental health professional addresses. CDA has generated lists by each county of all licensed dental health professionals to help local health departments contact providers once vaccines are available for Phase 1a Tier 3. Some jurisdictions have stated that they will only vaccinate dental professionals who work, not live, within their jurisdiction. We are working with the state oral health director to determine next steps with those counties to clarify eligibility.
• Guidance on vaccine appointment staggering. CDA is looking to hospitals, clinics and CDPH for guidance for how to stagger vaccine appointments so the process does not affect patient workflow. The stagger time implemented in many hospital settings currently administering vaccines to their staff is usually 2-3 days within team sections, meaning that it is likely small dental offices may need to divide the office into two groups to get vaccinated.
• Vaccine mandates. The state and counties are not planning to issue a mandate for any COVID-19 vaccine so long as they only have an Emergency Use Authorization. CDA will soon publish a resource for dentist employers providing an overview and considerations for employer-issued vaccine mandates, including medical and religious exemptions.
• Miscellaneous efforts. CDA is still conducting regular outreach to the governor’s office and Legislature on the following issues: government messaging to encourage individuals to maintain preventive medical and dental care during shutdowns; equitable PPE allocation if distribution efforts start up again; equitable rapid test distribution efforts once technology advances and if distributed from the state stockpile; small business relief/practice stability; permanent testing licensure and vaccine scope expansion; and PPE/COVID-19 rapid testing/COVID-19 vaccine reimbursement. More details on these efforts will be provided to members when the Legislature reconvenes in mid-January.

Dentists can find the latest updates on vaccine developments in the CDA newsroom.