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Pima County plans broad COVID vaccination push, but supplies & funding remain hurdles

How to pay for coronavirus innoculations 'a mystery' for cash-strapped local gov't

Pima County officials plan to vaccinate 345,000 residents by the end of March, and possibly more than 775,000 people by June under an accelerated COVID-19 plan, but only if the "vaccine supply is not an issue" and federal funding is available.

In the 18-page plan, described by Pima County Administrator Chuck Huckelberry in a memo to the Board of Supervisors, the county seeks to accelerate their vaccination program to cover nearly the entire population of Pima County by June 30.

But if more vaccine doses are sent to the county, a "maximum" version of the plan would cover everyone eligible and willing to get a vaccination by March 31. 

That would include expanding to six vaccination sites spread around the Tucson metropolitan area, and at least 12,000 vaccinations per day, with a possible expansion to over 16,000 vaccinations per day, Huckelberry wrote in the memo sent Tuesday.

"Based on the present supply of vaccines, it is clear we will have vaccination capacity in excess of vaccine supply," Huckleberry wrote. "An accelerated immunization plan is the quickest way  to reduce the present hospital capacity emergency, as well as reduce the number of community infections occurring with the coronavirus." 

However, Huckelberry warned that the county was facing a shortfall in funding, and said that it was a "mystery" to how new funds, allocated to the state by Congress in December, would come to the county.

Currently, the county is scheduled to get about 12,000 vaccinations per week, county officials said.

"We can only give as many shots as we've got," said Mark Evans, a Pima County spokesman. "If we had 12,000 shots day, we could be done by the end of February; there's just not that much vaccine. We rely on the state to tell us what they hear from the feds and vaccine manufacturers about supplies."

"We're doing everything we can, as fast as we can, to put shots in arms," Evans said.

On Tuesday, the Arizona Department of Health Services reported 8,559 new coronavirus cases, down from more than 11,300 on January 4.

In the first full week of January, more than 1,000 Arizonans died from the disease. Another 335 deaths from coronavirus were added to the state's tally on Tuesday morning. More than 10,400 state residents have died from COVID-19, and more than 636,000 have become infected — with another 8,559 new confirmed infections reported Tuesday.

Data from Johns Hopkins University showed that just two days ago, Arizona had the worst rate of COVID-19 cases per 100,000 people in the world, during a 7-day average. However, in recent days Arizona slipped to second place, falling behind Ireland with an average of 129.5 cases per 100,000 people over a weekly average, compared to 133.8 cases per 100,000 in the Emerald Isle. North Dakota remains the world recorder holder for cases per 100,000 after the state faced a huge spike in cases just before the Thanksgiving holiday with 184.8 cases. 

Overall, the United States has nearly 22 million cases, far outstripping the next closest country India, which has roughly four times as many people. 

By Friday, 123,862 Arizonans had received at least one dose of the COVID-19 vaccine, and 2,127 people are fully vaccinated after they received two doses of the vaccine. The state now has more than 180 vaccination sites, and that number is "expanding steadily," state health officials said. And, a partnership with the CDC has made visits to nearly 80 skilled-nursing facilities as part of the first phase of the vaccinations, and "dozens more" are scheduled through the end of the month. 

A report from the Arizona Department of Health Services showed that by Wednesday, Jan. 6, Pima County had vaccinated 22,224 people, the highest per-capita rate for any county in the state. Maricopa County vaccinated 74,824 people.

On Dec. 30, Arizona Gov. Doug Ducey ordered ADHS  to create a "state-directed" model for delivery of vaccines, overriding the plans of the counties throughout the state from county-set implementation plans, to a single "state-directed allocation model" run by ADHS to "ensure a uniform approach to the vaccination of high-risk and high-priority Arizonans."

"Across the country, news of delays in distributing the COVID-19 vaccine are being reported," Ducey said. "While Arizona has avoided many of these issues, any delay in shots being given to Arizonans is unacceptable. The development of the vaccine was called Operation Warp Speed, and the distribution of the vaccine should follow that same sense of urgency." 

"This is a health emergency, and we need all levels of government and our health system operating as such," Ducey said. "Vaccines don’t do any good sitting in a freezer." 

Near the end of this week, Pima County will shift into Phase 1B, a "large segment" of the population comprising about 275,000 to 325,000 people. Divided into two smaller subsections, the first part prioritizes people over 75 and older as they are "the ones most likely to require hospitalization and intensive care if infected." 

In the plan, county officials noted that they might have to provide "some level of telephone and limited on-site registration" for people because "it is likely that a significant portion of the population, particularly those 75 years of age or older, may not have the skills necessary to independently register online or have access to a computer or internet." However, officials did not give more specific details.

County officials will first encourage those older than 85 to sign up for vaccinations, as the elderly are most at risk and hospitals are still stretched thin.

There are about 1.1 million residents in Pima County, Huckelberry wrote, however, the county expects to only vaccinate about 720,000 people. This is because about 200,000 people are under the age of 16, and are currently ineligible for the vaccine because of a "lack of vaccine trials on this population," Huckelberry wrote. Additionally, the county estimates that about 20 percent, or 118,000 people, are resistant to getting the vaccine, and will wait to get the vaccine, or refuse it altogether.

"Therefore, approximately there will be 720,000 individuals requiring vaccination within the next six months," he wrote. 

"The county has established a minimal goal of 300,000 immunizations by March 31, 2021 if sufficient vaccine is available," Huckelberry wrote.  "If the present vaccination structure runs smoothly, an expected goal of 344,680 immunizations will be administered," he wrote. "If vaccine supply is not an issue and staffing and related resources can be procured, our mode can scale up to a maximum of 775,030 immunizations in that same time frame." 

Under the minimum targets plan, the county could vaccinate at least 345,000 people by March 31, and at least 944,410 completed by the end of June. Under the maximum vaccinations plan, the county hopes to vaccinate 775,000 by the end of March, and 1.78 million by the end of June. 

Huckelberry outlined his plan with several caveats, including questions about whether there would be enough vaccine does and staff. 

This assumes that all sites open on schedule with "adequate vaccine and staffing," that all sites meet their best performance numbers, and that "sufficient vaccine is allotted" to the county by the Arizona Department of Health Services on a "routine and predictable schedule." 

Under the plan, the county would use six vaccination locations, including two sites already in use at Tucson Medical Center and Banner University Medical Center North as well as expansions to Banner University Medical Center South, probably at Kino Stadium; a site at the Tucson Convention Center, one at the University of Arizona, and another at the Rillito Racetrack.

Kino-Banner will begin distributing vaccines by Jan.  15, and the University of Ariz. by Jan. 19, Huckelberry said. Rillito's plan is still in development, but is slated for February. 

While TMC would expect to cover at 109,500 people, officials plan to have up to at least 146,000 doses distributed at the Tucson Convention Center and Kino Stadium. And, the UA would be responsible for at least 73,000 doses under this plan by the end of June 30. 

The county also plans to add plans for semi-urban and rural areas, which covers about 17 percent of the county's population. This plan is still under development, Huckleberry said, but would include far western Pima County—Ajo, Lukeville, and Why—as well as southern Pima County—Sahuarita, Green Valley, Amado, Arivaca, Vail, Corona de Tucson—and northwestern Pima County—Catalina, Summerhaven, Picture Rocks, and Avra Valley. 

This effort cover up to 57,000 people. And, the county expects to cover another 21,000 at long-term care facilities through retail pharmacies, Huckelberry said. 

All told, even without the operation at Rillito Racetrack, officials aimed for 944,410 doses by the end of June under the minimum plan. With the racetrack under the maximum plan, the county would gain the ability to distribute another 228,000 doses, with a total effort of 1,780,100 by the end of June.

With the vaccines now being distributed requiring two doses for each person, separated by two or three weeks, the number of vaccination doses required to cover each recipient in the county is twice the number of residents.

Funding 'a mystery' for county

In his memo, Huckeleberry continued to worry about the cost of distributing the vaccines. "Current expenses have been born by Pima County, as well as our partners (TMC and Banner)." He noted that some "small, closed distribution points" including vaccinations at five other hospitals, including those managed by Carondelet, and a few health centers, and fire districts have "largely absorbed the cost of administration of the vaccine for their own staff." 

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The county has "exhausted" funding given to the county through the CARES Act, however, Huckelberry noted that the Consolidated Appropriations Act of 2021—signed into law on Dec. 27 after a short political fight over stimulus funds—has allocated $66 million to the state for vaccinations and $419 million for COVID-19 testing. 

"These amounts should be appropriately and proportionately passed through the State to local county public health agencies who are incurring both vaccination and testing costs at a pace that is not the highest since the COVID-19 pandemic began," Huckelberry wrote. 

"When and how these funds will be distribute remains a mystery at this point in time," he wrote. 

On Dec. 31, Huckelberry said that Pima County faces a $15 million shortfall with federal COVID-19 response funds nearly all spent, and some $55 million in additional aid will be needed to continue fighting the outbreak in Southern Arizona. "We are simply out of funding to respond to the pandemic," he said, at a time when costs are increasing faster than any other time during the coronavirus outbreak in 2020. Huckleberry said the county received about $87 million in federal funding from the Coronavirus Aid Relief and Economic Security Act, passed by Congress in March. The $2.2 trillion stimulus bill included $339.8 billion for state and local governments. 

The county spent $38 million on testing and contact tracing, about $8 million on medical and public health equipment, and another $1.5 million on a public health campaign, Huckelberry told county officials. Around another $7.8 million was spent on eviction prevention and utility assistance, and $2 million on a "food security" initiative that works with local food pantries.

The county also spent around $4.2 million on small business support, including rent assistance and help to upgrade infrastructure for outdoor dining and "touch-less" interactions, Huckelberry said.

The largest expense was $33.8 million for county personnel, which included effort on the coronavirus response, pandemic and sick leave, and leave for parents to take care of children because schools were closed. Some of this also included unemployment benefits. 

All told, the county spent nearly $99.3 million, or $15 million above the funds given to the county under the CARES Act, Huckleberry said. To continue contact tracking and vaccinations, the county would need another $55 million in aid, Huckleberry said. 

"The county will have to carry this additional financial burden through the General Fund, which simply means less funding available for any other purpose and that existing programs and department for those General Fund agencies will continue to be reduced in the latter half of this fiscal year and perhaps into next fiscal year," he said. 

He added that by December 31, the county had incurred another $15 million in medical and public health costs that will have to be covered by the general fund if "no other grant funding" can be found by June 30, 2021. 

And, the county Health Department said it will need another $45 million for testing, contact tracing, and vaccinations operations from January to June 2021. 

"We are simply out of funding to respond to the pandemic," he said in December. "This comes at a time when our costs and public health obligations are increasing faster than at any time during the pandemic."

The costs for vaccinating people during the first phase has "been largely borne by the Banner Hospital System and Tucson Medical Center," Huckleberry wrote on Tuesday. "It is not appropriate for these entities to continue to bear these  costs when moving to the general population for vaccination," he said, adding that he was allocating county funds through public health officials to reimburse Banner and TMC for their expenses. 

The county will also "bear fixed expenses" with other vaccination sites "once they come online," he said. "Bearing these expenses now without specific knowledge associated with reimbursement is a risk; however, a far greater risk is to delay the community vaccination process." 

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Paul Ingram/TucsonSentinel.com

A vial of the COVID-19 vaccine during a vaccination effort at Banner University Medical Center North Campus in December.