As the state of Arizona is quickly expanding its drive-thru COVID-19 vaccination sites in Maricopa County, some outlying counties are struggling with logistical challenges and an unreliable supply.
Nearly 150,800 vaccines have been administered at the two state-operated sites — State Farm Stadium in Glendale, which opened Jan. 11, and Phoenix Municipal Stadium, which just opened Feb. 1. That’s in addition to the 344,149 vaccinations administered at Maricopa County sites.
At the same time, officials in several outlying counties are struggling with a low and inconsistent supply of vaccine. They are having trouble planning ahead.
In Cochise County this week, officials were able to offer just 100 first-dose appointments because of a lower-than-expected allocation.
Some Cochise County residents are driving to the state-operated sites in Phoenix and Glendale, but that option “does insert some real inequities in access,” said Alicia Thompson, Cochise County’s health and social services director.
Last week Thompson said she felt sick to her stomach when she learned that the county’s entire allocation was 1,100 doses. She immediately set aside 1,000 for pre-booked second-dose appointments, which left just 100 first-dose appointments available.
“We just don’t have the vaccine and that is why I’ve been contacting state legislators and other people because it’s just very, very erratic,” said Dr. Edward Miller, chief medical officer for the Copper Queen Community Hospital in Bisbee, which is in Cochise County. “We get as high as 4,500 doses in one week and then this week we get 1,100, but 1,000 of those are designated as second doses … So we can do 100 new vaccines this week and that’s ridiculous.”
Cochise County had administered 13,100 vaccines as of Friday and 1,664 people, about 1.3% of the county population, had been fully vaccinated with two doses. Statewide, about 2% of Arizona’s population as of Friday had been fully immunized with the COVID-19 vaccine, state data showed.
Yavapai County also has had problems with supply and planning.
“Early on, we were told if we built this system, they (the Arizona Department of Health Services) would supply us with vaccine to hopefully push out vaccine in rural Arizona, not just in Maricopa and Pima counties,” Yavapai County Community Health Services Director Leslie Horton said.
“It takes a lot of work on rural counties to pull together the resources, the staffing, the support, and we’ve done that. Now we just hope that they’ll come through on their part and provide the vaccine that we need to run these.”
Governor says he has not forgotten about rural counties
State Farm Stadium in Glendale, which opened Jan. 11, administered 8,200 COVID-19 vaccine doses on Thursday and the state-run vaccine site at Phoenix Municipal Stadium increased its daily doses on Friday to 2,000, up from the 500 per day it was doing when it opened Feb. 1.
Arizona Department of Health Services officials say they’d like to ramp up to 12,000 doses per day at both sites. Both health department director Dr. Cara Christ and Arizona Gov. Doug Ducey say they have not forgotten about rural and outlying counties.
“We’re focused on all of our counties. Maricopa may be getting more attention for the reason that it’s the overwhelming majority population of our state. If you look at Maricopa and Pima you are talking about 85% of our state, so of course, we are going to focus our resources on that because that is where the people are,” Ducey said Friday during a visit to State Farm Stadium.
State officials say supply is a problem across Arizona, and they are optimistic that the situation will improve. And erratic supply is an issue across the U.S., not just in Arizona, Ducey said.
“What we need is supply. We’re going to open up a site in Pima County later in February,” Ducey said. “But what’s the consistent theme when you talk to anybody here … we’re going to say we need more inventory.”
Christ said the state is looking at Coconino and Yuma counties to set up large vaccination sites similar to State Farm Stadium and Phoenix Municipal Stadium. They could possibly be state-run or a state-county hybrid, she said.
A site in Yuma would be welcome news for Phoenix resident Stephanie Parra, who was born and raised in Yuma. Her family still lives there, including her aunt, who is hospitalized and critically ill with COVID-19, and her parents, who have not received a vaccine yet.
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“I know there is a great need. There is an entire state we have to worry about. But Yuma has been hit hard. I’m just frustrated. Why do we continue to forget about other parts of the state?” said Parra, a Phoenix Union High School District Board member who is the executive director of a Phoenix nonprofit organization.
“I want answers. They continue to say this (State Farm vaccination site) is a replicable, scalable model. I’d love a 24/7 site in Yuma. There’s plenty of space — a lot of wide-open space. Yuma is not being given the attention it deserves. It is literally being devastated.”
Yuma County has had the highest rate of COVID-19 infection in Arizona since the pandemic began, at 15,431 cases per 100,000 people as of Friday. The U.S. rate of COVID-19 infection as of Friday was 7,989 cases per 100,000 people.
Rural counties face unique challenges
Some counties say their week-to-week allocations from the state vary widely, making it difficult to plan in advance and schedule appointments because the supply is not consistent or reliable.
Yavapai County had administered more than 30,000 total doses, 90% of its supply, as of Friday, according to state data. It has one of the higher vaccination rates per 100,000 residents among Arizona counties.
But it’s been a “turbulent process,” Horton, the health director, said.
The county’s first allocation from the state in late December was a “sizable” 8,200 doses, Horton said, allowing a quick start to vaccinating health care workers and other phase 1A individuals. But after that, weekly allocations have varied from 3,900 to 12,200 to 5,000 to 2,400, she said, some of which the county was able to bump up after requesting more from AZDHS.
“We’ve had this very unsteady and ever-changing supply of vaccine each week,” she said. “What’s tough from my perspective is that instability of supply for planning purposes. To maintain these operations on a rural level, we need to know that we have a consistent supply coming, or at least have some sort of outlook on that supply so that we can plan for it.”
Cochise County officials face similar challenges. Cochise County has no problem getting shots into arms, with one of the highest rates of vaccine administration in the state. As of Friday, the county had administered 90% of its total supply. The problem is officials never know how many doses they’ll be getting week to week.
“We place our order and then we are supposed to find out ideally on Wednesday afternoon how many of the requested doses the county is getting and then how much each provider or vaccinator is getting,” Miller said.
Copper Queen Community Hospital, which is one of the county’s vaccine partners, has been requesting 1,500 doses per week and has never received “anywhere near that,” Miller said. The hospital system has enough medical assistance, nurses and volunteer nurses to administer the vaccines. The problem is supply, he said.
“We never know how many we’re getting and that’s really frustrating because we can’t plan,” said Thompson, the Cochise County health and social services director. “We can’t tell our community, ‘Well, this many new appointments are going to open up every week.’… It’s really been variable. It just goes up and down.”
Thompson said Cochise County would like to have a large drive-thru vaccination site at Buena High School in Sierra Vista, the county’s largest city. The goal is to do 7,000 doses per week, but the county will need more vaccine supply and vaccinators to make that happen, she said.
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She does remain hopeful. While this week was 1,100 doses, next week was initially 3,400, but then on Friday was increased to 5,400.
“Last week I was sick to my stomach, this week I’m doing the yippee skippy dance,” Thompson. “We ask them to tell us how many doses they can get out and into arms in seven days and that’s how many they ask for.”
Drop in weekly allocations was ‘a shot to the gut’
When Yavapai County got a weekly allocation of more than 12,000 doses, health care partners stood up three large points of dispensing, or POD, sites in Prescott, Prescott Valley and Cottonwood that combined could get out 2,000 doses each day, which Horton said took a lot of work in rural areas.
To maintain the sites and allocations to other providers, the county needed to continue to get at least 10,000 doses a week. But then the weekly allocations dropped — “a shot to the gut.”
“That kind of sent us into a panic, because here we had POD sites set up. We had made appointments for folks hoping for around 10 to 12,000 vaccines,” she said. “Everything that we need to provide mass vaccination on a local level is in place, but we’re just always waiting to find out for that coming week, what’s our supply going to be and is it going to be enough.”
When supply was low, the POD sites had to close down for a few days and stop scheduling appointments. Horton said it’s especially hard to bear given the success at state-run POD sites.
“Those sites plan in advance, they make appointments just like we want to do, and they get a steady supply of vaccine to accommodate those appointments,” Horton said.
“That on a local level is a little hard to take because we’ve had such an unstable supply and yet we’ve set up, on a local level, these same types of resources without any additional state support at this point in time, just their prompting to say we need to do better on a local level. And so we did. We stepped it up. We did everything that we needed to do to set these things up but that supply has still been very unstable.”
Horton says it’s an “equity issue.” She doesn’t think it’s fair that state sites appear to get stable allocations and can promise appointments while counties receive widely varying dose amounts each week.
‘It’s a scramble’ to get doses administered, Gila County official says
Gila County health officials also said their weekly doses from the state have fluctuated, posing logistical challenges.
“We’ve had no two weeks that have been the same. I don’t even know that we’ve had two weeks that have been within 200 (doses) of each other — they’ve all been completely different,” said Josh Beck, deputy director of public health for Gila County.
That makes it hard for the health care partners running vaccine sites to plan their operations.
“Once you get the vaccine, logistically you have to get with your partners, find out how many they can administer, allocate the vaccines to them. … When you get the vaccine in hand, you have to plan a clinic and get those administered within seven days to meet the governor’s executive order,” said Michael O’Driscoll, the county health director.
“We’ve had a lot of people step up to help us out, but once we get the vaccine in hand, it’s a scramble to get those administered.”
He said the county has been able to shuffle available doses between providers based on their capacity so that no vaccine has been taken back by the state for not being used.
O’Driscoll said his department has raised the concern with AZDHS and was told the county should get steadier weekly allocations moving forward.
La Paz County, a western Arizona county of about 21,000 residents, mushrooms with winter visitors each year, increasing the population up to five-fold. The already small public health department is facing added hurdles in rolling out a widespread vaccine program to reach year-round residents plus visitors.
“We’re limited by two things: by the doses of vaccine, and because we are a small county that’s medically underserved, it’s hard for us to find vaccinators,” said Greg Bachmann, La Paz County Health Department’s Emergency Preparedness and Response Coordinator.
The health department is the smallest in the state, he said, with nine full-time staffers and two public health nurses. Juggling the vaccine rollout with ongoing tasks of contact tracing and monitoring individual cases is a “huge challenge.” The county is working with fire departments, paramedics and National Guard members to recruit vaccinators.
“We’ve been living COVID almost 24/7 since March, for almost a year now, so it’s been a huge impact on this department,” Bachmann said.
Other rural counties, such as Apache County, said they are doing fine with the vaccine rollout and have additional resources they can use if needed.
“Our current allocation has been sufficient for our needs,” Apache County Public Health Services District Director Preston Raban wrote in an email.
He said no county doses have been allocated back to AZDHS.
“The state is doing their best to get the allocations to our counties based on our population sizes. None of our vaccine is being ‘taken away’ and sent down to their large vaccination events,” Raban said.
Managing rural Arizona’s expectations
Horton of Yavapai County said it’s tough on residents to see the success at state-run sites in Maricopa County while Yavapai County remains low on doses. Managing expectations has been a big issue, she said.
“(Residents) see national news saying that we’re getting hundreds of millions of doses of vaccine out, then they see the state news showing the big PODs vaccinating hundreds of thousands, and then on a local level, it just takes a lot of work and a lot of collaboration as well as a steady vaccine supply in order to accomplish what we aim to do,” she said.
In Gila County, officials say they’re getting doses out quickly but need more. Having available capacity but not enough doses to vaccinate faster means “a lot more calls into the call center and a lot more headaches,” Beck said.
The county’s health leaders said they’re fine with the state focusing on its PODs in Maricopa County.
“Those state-run sites are helping the state meet the guidelines set forth by the CDC and their formula. I think there’s a lot of pressure on everybody to get these vaccines out,” O’Driscoll said. “The most logical places to have those large events is where the biggest population centers are, where you can just fill up these clinics 24/7 for weeks in advance.”
Beck said vaccine efforts are easier at the rural level with fewer people. And, he said, county public health knows Gila County best, so “I think we can do a better job without the state coming in.”
Ducey talked to Pfizer leader, federal officials, about extra need in Arizona
State officials say things will improve in regions outside the Phoenix area, which has consumed significant state attention in opening and operating state-run vaccine sites.
“Right now we’re focusing on building these mass vaccination sites to get as many Arizonans through as we can,” Christ said Monday at a vaccine event.
Ducey this week met virtually with other U.S. governors, along with Pfizer CEO Albert Bourla and with David Hering, who is Pfizer’s North American Regional President for Vaccines, to discuss vaccine and distribution among the states. Ducey said he got some “very optimistic and hopeful answers.”
The message that Ducey wants manufacturers such as Pfizer and federal leaders to understand is that Arizona’s winter population is larger than its year-round population. For that reason, the state should be getting a larger vaccine supply, he said.
“They’ve been sending us shares pro-rata by population. That sounds like a fair way to do it. The issue Arizona has is our population swells in the wintertime,” Ducey said.
“If you recall the vaccine wasn’t available until sometime in late December. Our snowbird population begins to migrate in October and November. Those folks are already here. They haven’t been accounted for in the population statistics and we’re helping the federal government and the manufacturers understand that.”
O’Driscoll of Gila County said the state health department just started reaching out to local health departments to discuss possible regional vaccination sites.
“The next phase that we’re going to be looking at is smaller sites in communities where people who may not have access to a car can walk up, have it closer. We will also be getting it out to more pharmacies, more doctors’ offices, community health centers, so people can also go where they’re comfortable receiving their health care,” Christ said.
Christ said the state expects to receive a 16% increase in Moderna doses in the coming week. Rural counties mostly get Moderna doses, as its quantity and storage requirements are less strict than the Pfizer vaccine. The boost in Moderna doses will help rural counties, Christ said.
Ducey, in a letter to Arizona’s congressional delegation this week, said counties are seeing varying levels of success in vaccine distribution.
“Because Arizona is a home rule state, the jurisdiction and responsibility for vaccine administration lies with our 15 counties. Some counties have been doing an exemplary job while others have lagged behind,” Ducey wrote.
The solution to counties lagging in vaccine administration has been to reroute doses not used “efficiently” to more high-performing sites, namely the state-run sites. The state is moving those doses to other locations that can administer them faster. But for some rural counties, that means they’re getting even fewer doses into arms.
The state this week opened an additional 21,000 vaccine appointments at Phoenix Municipal Stadium after doses were redistributed from elsewhere in the state.
The state is still working on a records request from The Republic this week detailing how many doses have been reallocated from which sites and to which other sites.
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