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Logistical Challenges Ahead As Arizona Prepares For COVID-19 Vaccines

COVID-19 is surging in Arizona and the state’s hospitals are nearing capacity. But there is hope on the horizon. 

The U.S. Food and Drug Administration may grant emergency use authorization for a COVID-19 vaccine as early as next week. Experts expect high priority groups will have access to vaccines within weeks and the broader population could be vaccinated by spring. But getting Arizonans immunized will mean overcoming some enormous hurdles throughout the next few months.

This will be the largest vaccination program the state has taken on in decades. In 2009, the state coordinated efforts to vaccinate Arizonans against the H1N1 virus. Will Humble was head of the health department at the time. But he said that was comparatively simple since the goal was only to target the most vulnerable populations.

“This is different, because with COVID-19 the objective is to get to herd immunity through the vaccine," Humble said. 

The only way to stop the pandemic will be to get so many people vaccinated, the disease can’t spread. Pharmaceutical companies Pfizer and Moderna both report their vaccines are more than 90% effective. That’s good, Humble said, because the more effective the vaccine, the fewer people we need to vaccinate to achieve herd immunity. But even with a very effective vaccine, Humble estimates Arizona would need to vaccinate more than 4 million people. That will be a massive logistical challenge.

“These early doses, especially of the Pfizer vaccine, will probably need to be mass vaccination events," Humble said. 

The Pfizer vaccine, which is first in line for approval in the U.S., needs to be shipped and stored at ultra cold temperatures. So Pfizer plans on shipping nearly 1,000 doses at a time which will need to be used quickly once unpacked. Humble said it's likely that will mean organizing the entire staff of a hospital to be vaccinated in one day, for example. 

That may work in urban parts of Arizona, but will present challenges in other parts of the state, said Debbie McCune Davis, executive director of the Arizona Partnership for Immunization, a nonprofit which advocates for vaccines. 

"In some of our smaller communities, rural and Native American communities, the health care facilities are remote and they serve smaller numbers of people," Davis said. 

Another challenge is that the vaccines being developed by Pfizer, Moderna and AstraZeneca each require two doses. That will mean double the planning. 

“Arizona’s government runs lean and it runs even leaner under Gov. Ducey," Davis said. "We don’t have big departments of health services in our counties."

Compared to other states, Davis said Arizona will have to rely more on community partners, which will take coordination with hospitals, pharmacies and long term care facilities.

But Dr. Cara Christ, director of Arizona's Department of Health Services, said the state is prepared for that.

“This is building off of an existing system," Christ said. 

Christ's department is always responsible for distributing a certain amount of government funded childhood vaccinations each year. The Arizona Department of Health Services has been planning since spring to scale that system up. Arizona submitted its  draft vaccination plan to the Centers for Disease Control and Prevention in October.

The federal government will ration the first doses of a vaccine to the state based on population size — Arizonans make up about 2% of the U.S. population, so will likely get 2% of available vaccines. The state then plans to coordinate with counties to figure out where to send those doses to get them to targeted populations.

The CDC is recommending health care workers and residents of nursing homes get the first shots. The Arizona Department of Health Services estimates there are nearly 160,000 health care practitioners in Arizona and more than 16,000 people in long-term care facilities. 

After the first tier groups are vaccinated, Arizona’s plan prioritizes workers in schools and other essential services, people over 65 or with health conditions, followed by college students, incarcerated populations, people in homeless shelters, and hard-hit minority groups.

Christ said the state is also planning a system to keep track of who gets vaccinated to send reminders when it’s time for someone to get their second dose.

Christ said since September, the Department of Health Services has begun working with more than 500 potential vaccination sites.

“We are looking at all different types of distribution, so we are onboarding mass-vaccinators, we are onboarding the pharmacies, we are onboarding public health departments, so that we’ve got a variety of ways to access the immunization,” Christ said. 

At the county level, Maricopa County is in the process of recruiting medically certified volunteers to be on reserve to administer shots. 

In an email statement, a spokesperson for Maricopa County said the county is planning five "points of dispensing" around the county to administer the earliest doses of the vaccine. "In subsequent phases and when vaccine is in greater supply, diverse practitioners who have onboarded through the Arizona Department of Health Services will be eligible to administer COVID-19 vaccine to the general public,” the statement said. 

Throughout the pandemic, Humble has been critical of many of the state’s responses to the virus, but he’s more optimistic about Arizona’s vaccine plan.

“Looking at the information we have now, I think they’re in a good position planning-wise," Humble said. 

“Looking at the information we have now, I think they’re in a good position planning-wise.” — Will Humble

But planning is just the first step. Davis said another challenge will be public participation. 

“In Arizona we have an active anti-vaccine community. You’ve seen them actively recently as anti-maskers," Davis said. 

According to the Kaiser Family Foundation,  Arizona ranks 45th among states when it comes to the percentage of toddlers age 19-35 months who get fully immunized.

Christ expects even more skepticism than usual about a vaccine that’s brand new. She said the state will need to reassure Arizonans that while production has been sped up for COVID-19 vaccines, no safety measures were skipped during clinical trials.

"The vaccine is going to be just as safe as other vaccines are," Christ said. 

The stakes could not be higher. Davis said the statewide effort to vaccinate Arizonans is not just about ending the pandemic, but about the future reputation of our public health system. 

“If these vaccines fail, all the work we’ve done for so many years to get people to see the value of vaccinating their families to prevent disease could be harmed. We can’t risk that," Davis said. “We have to do this and we have to do it right.”

Katherine Davis-Young is a senior field correspondent reporting on a variety of issues, including public health and climate change.