Ducey reverses, Az gives nod to federal COVID vax sites in Pima County

After a weeks-long fight between local and Arizona officials over a federally supported COVID-19 vaccination effort in Pima County, Arizona officials relented Friday, allowing the county to set up sites that could serve more than 200,000 people.

In a letter to the Federal Emergency Management Agency, Dr. Cara Christ, head of the Arizona Department of Health Services, wrote Friday that she would "accommodate" the agency's offer and would work to ensure the county has a "delegated authority to independently partner with FEMA on a site if they deem it appropriate for their community." 

Christ's letter to FEMA might end an accelerating controversy that began about two weeks ago when FEMA 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 provide 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, Gov. Doug Ducey and Christ had rejected FEMA's offer, arguing that the effort would require supported 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. 

On Wednesday, 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" would be  hampered by governor's refusal to allow federal officials to set up the new vaccination sites.

This worry has risen Friday, after ADHS reported today that the B.1.351 COVID-19 variant strain, known as the South African variant, was confirmed in two test samples from the state.

After the state said it would not allow FEMA to operate the county site, the Pima County Board of Supervisors met during an emergency meeting Wednesday, and in an unusual unanimous vote passed a resolution asking the Republican governor to reconsider his decision turning down the vaccination help. If he refused, the county would attempt to circumvent Ducey, and ask federal officials to provide the vaccinations as part of a federally run site. 

The clash over another COVID vaccine site here comes as the county has detected a new variant of the virus 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. 

In her letter Friday, Christ told FEMA's acting regional administrator Tammy Littrell that she would allow Pima County to operate the sites with FEMA, but added several caveats sharply criticizing FEMA's other operations, and questioning the county's ability to manage a new site. 

"Arizona recognizes and appreciates FEMA’s willingness to provide a federally supported vaccination site in our state," said Christ. "As we have worked with our FEMA partners, we have continuously requested additional vaccine to support the unfilled capacity at our currently existing sites, often at the direction or request of FEMA leadership, but unfortunately, our requests continue to be denied." 

"Our sites are a national model — sufficiently staffed and resourced, highly efficient, and have significant unfilled capacity to administer vaccine," she said. 

"While we look forward to continuing our partnership with FEMA on the development of new COVID-19 response opportunities, the state does not need assistance in standing up additional fixed or mobile vaccination resources, and will instead continue to dedicate our limited resources to the state sites, rather than a FEMA-operated vaccination site," Christ said. 

Christ said that there were "significant concerns" about whether the FEMA site would impact Arizona's vaccine allocation. 

She also hit the county writing that "based on our recent experience with Pima County, we have concerns about their ability to adequately support your site, given their inability to financially sustain other COVID-19 related public health activities they have chosen to undertake, and have since billed the state for unapproved costs." 

"Given the dramatic financial constraints they claim to experience from these activities," she said, "we would like to get written assurance" that the Pima County and the federal government can "appropriately fund the activities required to operate a FEMA site until reimbursement from FEMA is obtained. Given that state or county funds would need to be used to obtain reimbursement, federal immunization funding will not be approved to be used on this activity, as it will take away from other critical activities Pima County has already committed to providing," she said.

Christ and other state officials did not directly inform the county about the change Friday. Ducey and his administration have had minimal communication with county and city of Tucson officials throughout the pandemic.

County: Ducey/Christ concerns about site 'unfounded'

Pima County Administrator Chuck Huckelberry responded to the move, issuing a public statement that he received a copy of Christ's letter to FEMA and thanking the governor for his "thoughtful reconsideration."

"On behalf of the Board of Supervisors, I thank Gov. Ducey for his thoughtful reconsideration and allowing FEMA to vaccinate more than 210,000 county residents," he wrote Friday. "The county Health Department will resume its planning with FEMA to begin administering these vaccines to county residents as soon as possible.

"I will be responding directly to Dr. Christ about her unfounded reservations and unwarranted criticisms expressed in her letter. Pima County has been operating multiple vaccination PODs since December without incident and with little to no state assistance," Huckelberry wrote.

Pima County has administered about 433,000 vaccines, giving first does to more than 278,000 people, while more than 176,000 people are fully vaccinated since the effort began. The county has maintained several county-run vaccination sites, and spun-up the site at the University of Arizona, which ran under county control until on Feb. 10 the governor's office announced that it would become a state-run site—eventually running 24-7 and inoculating up to 6,000 people per week. During a press conference Friday, Christ said that the side was administering about 3,000 to 3,500 doses per week.  

Christ said that other states had complained that FEMA sites had "long wait times," and that were "significant relationship challenges" caused by FEMA staff deployed to our rural counties and other states’ sites. Christ said that other states said that FEMA staff "poorly treated state, local, and healthcare partner staff" and alluded to an incident when a FEMA staff member was removed, and state and county staff "required crisis counseling."

During the press conference, Christ said that she sent the letter to delegate the authority to Pima County, "if they choose if that's in the best interest of their community. The only caveat of that is as long as it does not result in a reduction of existing vaccine supply to the state or impact state vaccine resources and operations. So the state remains ready to take these vaccines if they cannot be used at this pod—if they are unable to meet the requirements," she said. 

"We remain ready to administer them at our state sites that have significant unfilled capacity," she said. 

"I was pleased to learn earlier today that Pima County will now be permitted to work with FEMA directly to set up two federal vaccination sites in my district to serve low income and predominantly Latino neighborhoods," said Pima County Supervisor Matt Heinz. "This will help Pima County to achieve herd immunity weeks sooner and therefore allow us to reopen the economy much earlier to the great benefit of all county residents." 

"The additional infusion of 250,000 or more vaccine doses will also make it easier for people to find appointments to get vaccinated once these two sites start operating in early April," Heinz said.

'Arms race' to vaccinate before variants spread

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, 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." 

County officials also said that the U.K. variant of COVID-19—known as B.1.1.7—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 16,898 Arizonans who have died from COVID-19, with 24 deaths added to the total count on Friday morning. Two new deaths were reported in Pima County — among the 2,341 residents who have died from coronavirus here.

There were 571 new reported COVID-19 infections in the state Friday, following hundreds of new cases added daily this week. More than 838,000 Arizonans have been reported as testing positive for coronavirus infections, with more than 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.

During her press conference Friday, Christ showed that the state's "epi-curve"—a measurement of cases has been declining for 10 weeks. "Our epi-curve continues to go down and we'll continue to monitor that data," she said. 

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

'Turf war'?

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. 

This complaint was reiterated in the letter she sent to FEMA on Friday. 

"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 after the press conference that he had 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.