Pima County faces 'arms race' against COVID-19, Ducey rejects FEMA vaccine site

Pima County officials said that they are in an "arms race" against new variants of COVID-19, and that an opportunity to take the county's "aggressive" vaccine plan and "put it on steroids" has been hampered by Arizona Gov. Doug Ducey's refusal to allow federal officials to set up a new vaccine site could cover more than 200,000 people here.

Following Ducey's decision, in an unusually unanimous vote, the Pima County Board of Supervisors passed a resolution Wednesday that would ask the Republican governor to reconsider his decision turning down the vaccination help. If he refuses, the county will attempt to circumvent Ducey and ask federal officials to provide the vaccinations as part of a federally run site. 

The move comes as the county has detected a new variant of COVID-19 that may be more infectious and could lead to more cases, as local health officials hustle to achieve some kind of "herd immunity," and vaccinate thousands of county residents, even with a yet-constrained vaccine supply. 

The back-and-forth began about two weeks ago, when the Federal Emergency Management Agency offered to set up federal point-of-distribution sites, or PODs, in Pima County that would be focused on disadvantaged populations, located at El Pueblo Community Center and Kino Event Center.

As part of the plan, FEMA would provided up to 6,000 doses per day of Pfizer vaccine for three weeks, plus another three weeks for the necessary second shots. FEMA also offered the possibility of another two weeks of one-dose Johnson & Johnson vaccine, up to 80,000 doses, county officials said. 

However, Ducey and Dr. Cara Christ, the state's director of Health Services, rejected FEMA's offer, arguing that the effort would require help from the state. Arizona officials later said they would rather FEMA give the allocated vaccine doses to state officials so they could be distributed as they determine.

In a letter Monday, county officials and the mayors of Tucson, South Tucson, Oro Valley, Marana, Sahuarita, asked Ducey to reconsider his decision. 

"We have made significant progress in vaccinating a large portion of our population, particularly those who are most susceptible to hospitalization or death," they wrote, adding that along with the state-run POD at the University of Arizona and several regional sites, the county was also enlisting the assistance of our community health centers and partner organizations to provide mobile clinics to disadvantaged and minority populations.

"Pima County is prepared to provide any and all assistance in setting up this POD such that it does not require resources from the State. In addition, the vaccine supplied by federal policy will not deduct from the State vaccine allocation," the mayors and councilmembers wrote.

During a press conference on Wednesday, Dr. Francisco Garcia, the county's medical director, called the FEMA offer an opportunity to put the county's "aggressive" vaccination plan "on steroids." 

He said that it would be "unconscionable not the take the offer immediately." 

"How anybody can say no to an additional 200,000 doses of vaccine is difficult for me to understand," Garcia said, describing the effort to get shots to people before more infectious variants of the deadly virus spread here as "an arms race."

Through the last few months, state and county have often wrestled over vaccine allocations, funding, and eligibility requirements. In December, Ducey wrested some control of vaccines from county health officials, ordering Christ to create a "state-directed" model for vaccine delivery, and on Feb. 10, the state took over vaccinations at the University of Arizona. At the same time, in early-February, the county felt the pinch of a dramatic cut in vaccine doses from the state. 

During the meeting, Pima County Administrator Chuck Huckelberry outlined how the FEMA effort would help Pima County. "We still believe it's necessary for community," he said. 

Supervisor Rex Scott went further. "For state government to get in the way is just reckless and irresponsible," he said. 

While Supervisor Steve Christy, the lone Republican on the county board, criticized both the state and the county for an "underlying current of irritation and acrimony," he voted to approve the resolution. "I'm in favor of anything, anywhere that brings more vaccines into Pima County." 

“I’m pleased that my colleagues on the Board of Supervisors joined me and voted unanimously to request that FEMA move forward and set up additional vaccination PODs at the El Pueblo Community Center and the Kino Event Center, and in doing so, provide our community with hundreds of thousands of additional doses of critically needed vaccine," said Supervisor Matt Heinz, a practicing medical doctor. "The exceedingly rare 5-0 unanimous vote highlights that this issue is not about politics – it's about equitably providing these life-saving vaccines to our community members as quickly as possible," he said. 

"That Gov. Ducey would play games with the lives of Pima County residents by rejecting this federal assistance and additional vaccines for our community is just despicable," Heinz said. "His rash and politically motivated decision put lives on the line and attempted to hold back our economic recovery as well. It is an affront that will not be forgotten any time soon by the voters of Pima County."

The conflict over the FEMA site also comes as the county moves to shelter dozens of families who were released by Border Patrol after seeking asylum in the U.S.

On Wednesday morning, Huckelberry noted that a woman, her daughter and granddaughter were released by Border Patrol, and that during medical triage at the Casa Alitas welcoming center, the shelter discovered she had COVID-19 and that her blood oxygen-level had plummeted to just 68 percent. She was rushed to a hospital, where she remains in the ICU. 

"We have not had very many positive cases, until yesterday," Huckelberry said. He added that county officials were working with Border Patrol officials, to understand "how that happened and why that happened." 

"That should not have occurred," Huckelberry said. 

On Wednesday, the Board of Supervisors authorized Huckelberry to seek a contract to transport migrants from remote Border Patrol stations. In recent weeks, agents have released migrant families in Yuma, and over the weekend began releasing them in Ajo. On Wednesday, Border Patrol agents began dropping people off in Gila Bend, Arizona prompting the town's mayor to call an emergency. 

County officials also said that the U.K. variant of COVID-19 had been detected in Pima County. While the variant of COVID-19 emerged in Arizona, it wasn't until this week that it popped up in tests done by the private company T-Gen for the county, which samples COVID-19 tests and wastewater samples to look for new variants, Garcia said. 

This doesn't mean there were just 2-4 cases, he said, but rather that the new version of COVID-19 has been "circulating in this state" and it was  "just a matter of time to get to Tucson." The U.K. variant may be "more transmissible," and could cause more complications, including higher hospitalizations, and even deaths. 

The new variants of COVID-19 remain a worry even as national numbers show an encouraging picture from vaccinations. In the U.S., at least 70 percent of those 65 and older have received at least one vaccine dose, and COVID-19 deaths have dropped below 1,000 per day for the first time since November. 

There have been 16,842 Arizonans who have died from COVID-19, with 44 deaths added to the total count on Wednesday morning. Four new deaths were reported in Pima County — among the 2,338 residents who have died from coronavirus here.

There were 605 new reported COVID-19 infections in the state Wednesday, following 507 new cases added on Tuesday. More than 837,000 Arizonans have been reported as testing positive for coronavirus infections, with nearly 112,000 cases just in Pima County to date.

State official said that nearly 905,000 people aged 65 and older had received at least one dose of the COVID-19 vaccine, and nearly 3 million doses were distributed statewide.

"We are just now starting to feel like we can catch our breath," Garcia said. 

During a press conference Wednesday at the UA site, an occasionally testy Ducey batted away the idea that his refusal to grant FEMA's request was part of a "turf war." 

While he defended his decision to refuse FEMA's offer, he also told reporters that he would reconsider his decision. "I'm going to revisit this issue because the Board of Supervisors feel so strongly but the objective is going to remain employed in arms." 

"I'm going to say that we're going to continue to work with the federal government," he said. "I would have been the federal government a lot of credit for their success and working with the private sector in the production and distribution of the vaccine, and we're going to continue to work in concert to distribute the vaccine." 

He later added that it was his "objective" to get the vaccine out. "There's no turf war here, we're in the business of distributing the vaccine." 

"We need supply. We need vaccine. It's pretty simple, give it to us and we'll get it before his arms all over the state," Ducey said. 

Christ pushed the idea that FEMA should simply give the state more vaccine doses. The county, or the state would have to come up with a "huge list" of items to make the FEMA site work, including the cold chain storage, the pharmacy support, the vaccinators support, the communications, the registration system, she said. 

"There's a huge list of what the state has to provide in order to operate," Christ said. "We already have a lot of that infrastructure in place where all we would need to do is add a couple hundred appointments to each hour, and we would be able to significantly increase the capacity, if we just got the vaccine without having to add additional resources. It will take FEMA a while to mobilize as well. So by the time we start to get that vaccine, we could have gotten out quicker through this, then by the time they set aside and get it running." 

Dr. Richard Carmona, the former U.S. surgeon general who has been leading the UA's campus reentry plans, made a similar argument noting that outside the press conference dozens of cars were moving along the UA's mall. Carmona said the site could cycle through people through their vaccinations in under 30 minutes, including a 15-minute observation period. 

"That's amazing and yet, they haven't rested on their laurels," he said of those running the UA effort. "They're talking about you are doing it faster and better," he said. He added that someone couldn't just set up at a location without understanding the logistics, and how to increase the frequency of cars. "It would be a failure," Carmona argued. 

The UA site began as a county-led effort earlier in the year, but on Feb. 10, the governor's office announced that the UA mall would become a "high-capacity" COVID-19 vaccination site, with plans to eventually operate 24-7. Ducey has often pushed for the 24-7 drive-thru sites, and noted during the press conference that President Joe Biden and Vice-President Kamala Harris virtually toured a facility in Maricopa County and called it a "model" for the rest of the country.

"We know that if we can double or even triple our capacity, if we can get the vaccine," Carmona said. "We're not working 24-7 because we don't have enough vaccine." 

Christ said that state officials were "surprised" by the lack of demand for vaccinations last week, and said that they hoped that by opening up the availability for vaccinations will add demand for the next several weeks. They also said that they expected to have more vaccines available from the federal government, which would help give the state the supply to vaccine everyone over 16 years of age at the state-run POD at UA. Other counties have lowered their eligibility requirements already, but 

Last week, President Joe Biden outlined his approach to vaccinations as the White House pushes to dole out 100 million shots in 100 days. During a speech on March 18, he said that he was deploying nearly 6,000 federal personnel, including FEMA, active-duty military, and  Department of Health and Human Services to support vaccinations. 

"We’re also supplying vaccines to community health centers to reach those who have been the hardest hit—the hardest hit—and suffered the most, especially black, Latino, Native American, and rural communities," he said. "This is really important—because we believe that speed and efficiency must be matched with fairness and equity." 

The federal government is already involved in several ways in Arizona's vaccination efforts. FEMA employees have aided Pima County's vaccination efforts at small pop-up vaccination efforts in the Tucson area, and the Arizona National Guard has been deployed across the state, including an event this week in Mohave County along with members of the Air Force Reserve. 

Reportedly, after telling reporters he would reconsider his decision, Ducey said he ahd decided not to accept FEMA's offer. 

"We are the county, and we will roll with the punches," said Garcia. "I wouldn't impute any motive on the governor," he said, but he said that the county could move forward to ask FEMA to set-up the POD regardless. "What happens if the governor says no? We make a direct appeal to FEMA. This is relatively precedent setting for FEMA to take such an action, and they probably won't do this lightly. So, we're exercising levers we haven't in the past," he said. 

Garcia called the lack of vaccine doses, "the hunger games" and said that the county would "have to take relatively aggressive actions to bring vaccines into our community because of the vaccine shortage." That, he said is not the state's fault. 

Garcia said that the FEMA site would help the county continue to focus on disadvantaged communities, including the city's large Hispanic community. State data shows that about 4.7 percent out of 787,000 vaccinations have gone to people who identified themselves as Hispanic at the state-run PODs, while about 15.8 percent of 417,000 vaccinations in the county has gone to people who identify as Hispanic. "We've been able to achieve a degree of penetration in a vulnerable community that's far beyond what the state has done," Garcia said. 

"At the end of the day, I will advocate for the people in Pima County, and I believe this is something that is critical and beneficial for Pima County, and it is critical and beneficial for the state," Garcia said.