Pima County facing 'razor thin' COVID vaccine margins, forced to slow doses following state cuts

A lack of vaccine doses provided by the state of Arizona has forced Pima County to sharply cut first vaccination appointments, with the cutbacks in doses putting plans for clinics in rural parts of the county "in jeopardy," county officials said Friday. 

In a memo to the Pima County Board of Supervisors, County Administrator Chuck Huckelberry called the state's allotment of vaccines "frustratingly opaque" and said that communication with state officials was "limited." Huckelberry also said that the county's budget was under severe pressure, writing that "our fiscal position has severely deteriorated" because of COVID-19 costs.

The state's process of determining how many vaccine doses to send, and where to send them, is a "black box" as far as local officials are concerned, he said.

"The lack of predictability and weekly fluctuations in vaccine supply, has impacted our ability to commit to future vaccination schedules that accommodate the needs of our community. Despite embracing the States own direction of effectively and efficiently administering COVID-19 immunizations and meeting our published monthly interim goals, we have not been assured by the State that there is adequate vaccine to continue on this path," Huckelberry said.

On February 4, the county was informed that it would receive just 17,850 doses of COVID-19 vaccine that week, a 40 percent cut from the 29,850 doses per week that Arizona state officials have provided through late January. 

"While the state’s allotment system has been frustratingly opaque, Pima County believed in good faith the state would only maintain or increase that weekly allotment over time. We then allowed our registration system to create appointments into the future based on that expected supply," Huckelberry said.

'We have the infrastructure, but we don't have the vaccines'

During a call with reporters on Friday afternoon, Dr. Theresa Cullen, the county's Health Department Director, said that the county operating was on "razor-thin margins" after it was allotted just 16,300 doses of the Moderna vaccine, and the county did not receive an allocation of Pfizer vaccines from the state. Some vaccination sites did receive about 1,500 doses of Pfizer vaccines, along with another 1,200 doses of Moderna vaccines, she said. 

The reduced supply of vaccine doses will have a "ripple effect," Cullen said, adding that the county can administer more than 29,000 doses per day, but that effort is hampered because of a lack of vaccines.

"We have the infrastructure, but we don't have the vaccines," she said.

The cuts come just after Arizona Gov. Doug Ducey announced that the University of Arizona will become a state-run point-of-distribution, or POD, serving Southern Arizona. There are two state-run PODS in Maricopa County that have distributed more than 226,000 vaccine doses, fully vaccinating nearly 44,000 people. On Wednesday, Ducey and University of Arizona President Robert Robbins, announced with great fanfare that the UA campus would become a state-run site capable of putting more than 6,000 vaccine doses in people's arms per day.

However, the new site does not come with additional vaccines, rather those vaccine doses will be pulled from the county's allotment from the state. 

County officials were hoping to open a site at Rillito Park, but the state chose to locate a state-run vaccine site at the UA instead, Huckelberry said. Appointments for the new UA site will go through the state, rather than the county, and Huckelberry worried that this would create a third registration system that Pima County residents could access for vaccine appointments that will "invariably cause confusion," Huckelberry said. 

"The state has cut our allotment nearly in half, which means we will limit our first dose appointments for the near future. This situation is made worse by the state’s intention to supply the new State POD at the University of Arizona from the county’s weekly allotment," Huckelberry said. 

"We understand the target capacity of this POD is to be 6,000 per day. I have, since the beginning of planning for this State run POD, continually cautioned that it should not open until there is an assured vaccine supply as our existing PODs in Pima County are concurrently using all the vaccine that can be supplied by the state," Huckelberry said. 

"Based on the States lack of assurance about the required vaccine supply for Pima County, I do not understand the push to open another State vaccination site at the University of Arizona at this time," he said. 

Cullen said that she didn't know how many vaccines will be sent to the University of Arizona point-of-distribution, or POD. "We just don't have insight into that now," she said. She also said that it was unclear how many people from Southern Arizona would make appointments at the new state-run POD at the UA, and that would impact the county's ability to predict how the new vaccination site will affect the county's long-term plans. 

The state's cut means that the county might hold back on making first appointments for vaccinations to ensure that second doses are available, a decision which "anguished" county staff, she said. 

County officials are concerned about how the state-run PODs could contribute to vaccine inequality in the state, instead of ameliorating it, Cullen said, adding that drive-thru vaccine sites only worked for people who have cars, or access to cars.

"You can't take a Sun Tran bus through the lanes," she said. 

To solve this, the county has worked  to develop supplemental efforts to reach people in disadvantaged populations where income, ethnicity, age, a lack of access to transportation and technology make it harder for people to get vaccinated. In his memo, Huckelberry highlighted the county's first mobile vaccination clinic, held on Feb. 6 at St. John’s Evangelist Church near Valencia Road and 12th Avenue. The site vaccinated 511 area residents, the majority of whom were Hispanic. 

Huckelberry said that a vaccination clinic designed to serve the county's African American population on Saturday, Feb. 13 will be rescheduled because of the lack of available doses.

The county has also opened up "pop-up" vaccination sites, including a site with the Desert Senita Clinic in Ajo, a site in Amado at the Sopori Elementary School, as well as sites in Three Points, Old Vail, Sahuarita and Green Valley. 

"Consistent with the current prioritization system, more than 6,000 vaccines have been administered by this group of partners," he said, adding that an immunization effort in Green Valley distributed 3,000 vaccines over three days. "Initially, we had committed to ongoing mobile vaccine sites in this as well as other rural areas; however, the lack of vaccine availability has put those endeavors in jeopardy," he said. 

The UA site, he said, "will simply detract from our ability to provide vaccinations to our other partner sites that are prioritized for age vulnerability and disadvantaged communities. Vaccines supplied by the Federal government to the State each week is a fixed amount. Opening a State POD will reduce County vaccine supply as this is a zero sum game. What the State takes for their POD decreases everyone else’s supply," he said.

Arizona's vaccine supply decisions a 'black box'

"The state asked Pima County to set up a system of mass vaccination. We did. We now have capacity to vaccinate up to 10,000 people a day, possibly 14,000 to 15,000 if we open the Rillito pod. The limiting factor is the supply of vaccine," he said. 

And, he said that state officials have not given the county a "clear response" or clarification about why Pima County has only received about 10 percent of the state's Pfizer vaccine allocation, even as the county has facilities to handle the doses—which require super-cold storage to remain viable. "It appears 90 percent of the Pfizer vaccine has been used in Maricopa County and a substantial portion has been used by the State-operated 24/7 PODs in Maricopa County." 

Huckelberry called the site's allocation effort a "black box with no transparency." 

Huckelberry also criticized the state's response to questions after officials said that the reduction in supply was because the county had not used a significant portion of its allocations. "This is a demonstrably inaccurate statement based on the State’s own data and Vaccines by County webpage," he said. 

On Friday, Cullen said that the county had delivered about 91 to 95 percent of available vaccines. "Those are great numbers, and where we would like to be on a regular basis," she said.

Financial hole remains

Huckelberry noted in his memo that the Coronavirus Relief Act awarded $87.1 million to Pima County, as well as $95.6 million to the City of Tucson. And, the state received $1.856 billion, and has only reallocated about $440.7 million, or about 24 percent to the counties and cities affected by COVID-19. 

Huckelberry said the county was seeking more "transparency" about how the money was allocated, and he said that the state has received $416 million for testing and $66 million for vaccinations. "To date, we have not received any of these funds for those purposes even though we continue to make significant expenditures in support of our regional vaccination centers and COVID-19 testing," he said. 

He added that Arizona's 15 counties are "on the frontline regarding the COVID-19 response," and are responsible for absorbing testing, vaccinations and other costs. However, while the state received more funds from a second round of coronavirus relief funds, "it has not made any distribution of those funds to the frontlines, the county public health agencies." 

"Because of the lack of reimbursement for our COVID-19 continuing expenses, our fiscal position has significantly deteriorated," he said. The county faces a $10 million hole after expenses exceeding the $87.1 million. The county hopes to "recapture" some of that funding through funds from the Federal Emergency Management Agency, however, total costs may mean that the county's available balance will drop from $111 million to around $53 million. 

"However, we continue to incur costs in our COVID-19 response of approximately $58 million each year," he said. :This means that if we are able to end this fiscal year with a fund balance of $53 million, and continue to incur expenses that we have incurred to date without reimbursement, our fund balance will decrease to $0 for budget planning in Fiscal Year 2021/22 that begins July 1, 2021." 

In response, Huckelberry moved to consider terminating testing on March 2, and focus on vaccinations.