Missed Shot: County falls just short of mid-year COVID vaccination goals

As 2021 reaches its midpoint, Pima County continues to push for more people to get vaccinated.

At the start of June, the Biden administration announced their “all-of-America” sprint to have 70% of adults vaccinated with at least one dose by July 4. However, as the holiday weekend grew close last week, Biden conceded that the country would not reach the goal.

The state of Arizona and Pima County hadn’t hit the goal at the start of the holiday weekend last week, either.

As of July 4, the U.S. falls just short at 66.7% of the U.S. total adult population vaccinated with at least one shot. According to County Administrator Chuck Huckelberry’s July 1 COVID-19 update memo, 62.1% of adults have received at least one dose in Arizona and 69.6% in Pima County.

Pima County Health Department Director Dr. Theresa Cullen had hoped the county could reach the goal, but said last week it would fall short of hitting the number by Independence Day.

“We’re not going to meet it,” said Cullen. “But we’re close, hopefully we’ll be at 69%.”

Reaching the elusive herd immunity has proven difficult as vaccine administration steadily decreased beginning in April. While some people remain hesitant to get a shot or simply are refusing to do so, health officials attribute the struggle to vaccinate to a lack of access.

“One thing we hear repeatedly from people that are working hourly jobs is that they’re really fearful about getting vaccinated because they’re not salaried and they may or may not have any kind of medical leave,” said Cullen. “Almost everybody knows somebody who got a little sick and if they get sick, they’re going to miss work and they can’t afford to miss work especially with the economy.”

The county has shifted to provide mobile vaccinations sites, partnering with local organizations to administer vaccines at a church, school, or cultural center. In April, the county partnered with FEMA to administer vaccines through two mobile sites that changed to several different locations where they hoped to make it easy for those most at risk and vulnerable to get their shot.

As of June 26, the FEMA mobile unit vaccinations have ended and large vaccination sites shut down, with Gila River Arena in Glendale administering final doses on June 28.

However, the vaccination effort continues and the CDC has funded several initiatives across Arizona to address health disparities due to COVID-19 and the barriers to vaccination.

The Arizona Prevention Research Center (AzPRC) at University of Arizona’s College of Public Health received a one-year supplemental grant award of $500,000 from the CDC to increase vaccinations among rural, border and underserved Arizona communities and identify barriers to increase confidence in COVID-19 vaccines.

Tomas Nuño, the lead and co-investigator for the effort, said AzPRC will use its existing network to conduct the research, partnering with the university’s mobile health units, which have been administering COVID-19 vaccines to rural, uninsured and farmworker populations in Southern Arizona since February.

The funding would be used to conduct listening sessions with AzPRC’s Community Action Board members and other key stakeholders to identify barriers to increased vaccinations and identify solutions. It would also support the Mobile Health Units to increase vaccine confidence and conduct surveys to understand barriers to getting vaccinated.

Nuño said they hope to learn what factors lead to “confidence or no confidence in the COVID-19 vaccine.” They would be asking what people consider their concerns about the COVID-19 vaccine, how they get their information and who might have influenced their decision, like their provider or family and friends. From the work conducted by the Mobile Health Units, Nuño said practical issues play the biggest role in the vaccination effort for the Hispanic community.

“For the Hispanic community it’s not about hesitancy so much, it’s more about access and availability and fear of what are the requirements to get vaccinated, fear of giving personal information or work requirements, not being able to get off work,” said Nuño.

Nuño is aware a lot could change over the course of the year. He said they have already discussed the possibility of addressing the need for a booster shot or a surge in the winter, or even a decline in need with high vaccination rates.

“Hopefully we can increase the confidence and increase the access,” said Nuño. “So it starts with the ease of access in providing it and then confidence and then actually getting vaccinated.”

Vaccine effective at preventing and lessening COVID symptoms

With months of real-world data supporting the effectiveness of COVID-19 vaccines reported by the CDC, Arizona Healthcare, Emergency Response, and Other Essential Workers Surveillance (AZ HEROES) conducted their own real-world study of mostly vaccinated frontline essential workers, which showed the effectiveness of the COVID-19 vaccine at preventing breakthrough infections, as well as lessening the severity, length and viral load for those infected.

According to Jeff Burgess, principal investigator of AZ HEROES, they found that two doses of the mRNA vaccines, either Pfizer or Moderna, were 91% effective in preventing COVID-19. For breakthrough cases, those who got COVID days after their first dose or had gotten both doses, “the infection was much shorter, much less severe than if you hadn’t been vaccinated and furthermore, there was less virus there and for a shorter period of time than if you had not been vaccinated.”

For Burgess, these findings showcase how remarkable the vaccines are and how lucky we have been.

“We’re really fortunate that we have these messenger RNA vaccines and they’re as effective as they are,” said Burgess. “These are not brand-new vaccines. The history of messenger RNA vaccines goes back 10 years and they’ve been improved over time, and I think that we benefited, when the COVID-19 pandemic occurred, from all that previous development. But we’re also fortunate, at least to this time, that so far it’s been effective against the variants, maybe not quite as effective, but still been effective against all the COVID-19 variants that have occurred.”

Burgess said there’s reasonable evidence to support that the Delta variant, which is becoming the dominant strain across the U.S., is more infectious and more severe. Since January, Translational Genomics Research Institute (TGen) in Flagstaff has reported 122 cases of the Delta variant. The county reported seven cases of the variant in the last two months, according to Huckelberry’s July 1 memo.

“We are worried about it, but it’s one reason why we monitor our daily cases so much and why they seem to be pretty stable right now,” said Cullen. “The vaccine seems to be as protective, so we’re not worried about that. What we’re worried about is it getting in the unprotected, unvaccinated community because it will spread quicker.”

More local COVID cases in areas with lower vaccination rates

County Administrator Chuck Huckelberry’s June 8 memo shows 160 cases of COVID-19 between May 30 and June 5 plotted across a map of Pima County, highlighting areas with vaccination rates 75% or higher or 40% or less. The majority of cases fall within areas with lower vaccination rates. While the data may support the efficacy of vaccines, Cullen has not seen what they would have liked in the targeted areas.

“Ideally what I would be showing is that we target a census tract, which we’ve done, we go in, we offer vaccine, people get completely vaccinated, which might be two shots, maybe one shot, and then we see the rate go down,” said Cullen. “That’s what we want to see. We have not seen that yet.”

According to Cullen, it may be because they have only begun targeting areas by census tract about two months ago or because they have not targeted smaller census tracts, which could show significant differences versus ones that may have higher populations, requiring more vaccinations.

In order to target those areas, Cullen hopes people will request a mobile vaccination clinic for their community. The county health department also received a small grant from the National Association of County and City Health Officials (NACCHO). The COVID-19 Community Champions mini-grants will provide eight awards of $2,500 each to community-based organizations in Pima County, serving racial and minority, rural and highly impacted communities in order to increase access to COVID-19 vaccination information and resources through trusted community members, leaders and messengers. Applicants have until July 12 to apply.

The Pima County Health Department also received $6.5 million from the CDC to address COVID-19 health disparities among high-risk and underserved populations, including racial and ethnic minority populations and rural communities, but with a focus on testing.

In order to increase and improve testing for those communities, the county will provide home testing for the first time. Cullen said the county currently tests people who have had contact with COVID-positive patients, such as people who are quarantining because they’ve been named as a contact. The county asks those people to test on day five of their quarantine, but are unsure of how many people actually get tested.

“For almost all of them, they have to go somewhere,” Cullen said. “We don’t know how many people test. We believe it’s a high number. We do follow up with them, and people self-reveal that they’ve tested. This is to accelerate the ability for people to make it easier for people to be able to take home tests for COVID.”

Further, Cullen hopes to facilitate the access of care after testing positive.

“It’s really up to us to say, ‘If you test positive, here’s the phone number, we’re going to make it really easy for you to get care and to get follow-up,’ and that’s the point,” said Cullen. “We want to remind people that case investigation and contact tracing is the way we really can stop the pandemic right now.”

The county has remained at below 50 cases per 100,000 individuals, fluctuating between 20 to 50 positive cases for more than a month.

“That’s a number that we can handle with case investigation, contact tracing with no problem,” Cullen said.

The county also plans to work with community-based organizations to offer home testing in place of their mobile testing sites. The funds would be used to improve the data collection and accessibility.

“We’ve been able to use data to identify at-risk communities and so our plan is to just make that more easily accessible,” said Cullen. “Work with the community to see what it would take for them to have a better understanding and ability to use the data that’s out there, because while it seems intuitive, I think it’s not intuitive and I think for some people, they don’t understand yet or don’t even know that it exists.”

In order to address disparities created by COVID-19, the county will

hire six community health workers, trained in public health, according to Cullen. They would provide referrals to community-based services, including eviction prevention, food security, transportation and outreach in the community and at mobile testing and vaccine events.

A part of the plan also looks to build on the need for trauma-informed care, especially following the pandemic, not only for public health workers, but also for the community at large.

In CDC’s latest Morbidity and Mortality Weekly Report (MMWR), a little more than half of the 26,174 surveyed state, tribal, local and territorial public health workers reported symptoms of at least one mental health condition in the past two weeks. According to the report, symptoms were more prevalent among those who were unable to take time off or worked 41 hours or more per week.

“The goal is to develop a way to identify and address the needs of people that have had trauma secondary to COVID, and while the focus will be on public health workers, it won’t be limited to public health workers, it’s really to work with the community,” said Cullen.

The county also plans on partnering with local legal organizations focused on providing legal services to communities with low socioeconomic status to create a dedicated public health legal team. The team would provide expedited referrals and legal support focusing on eviction prevention, domestic violence, child abuse and public benefits.

While the majority of the funding focuses on testing, the county would distribute $925,000 to community-based groups disproportionately impacted by COVID-19 to help people access COVID testing, contact tracing and vaccinations, while also embedding a community health worker.