Take a Shot! Local health officials work to overcome vaccine hesitancy

click to enlarge CHRISTINA DURAN/TUCSON WEEKLY
Christina Duran/Tucson Weekly

On a recent Friday night, Paul Madero walked into downtown's Fox Tucson Theatre mobile vaccination site following almost a month in the hospital thanks to a mountain bike accident. Madero's daughter, April Madero, had already gotten her family vaccinated, but was unable to get her father an appointment. April saw the Fox Theater offered vaccinations without an appointment and brought her father.

Madero, 65, did not have much hesitation as his daughter made the appointment for him.

"She's the one that made the appointment, so I figured it was safe," said Madero.

On recent Friday nights, as some people were heading home from their jobs and others were headed out for a night at now-open bars and clubs, the Fox opened its doors, not for a show, but to provide no-appointment walk-in Moderna vaccinations.

But on Friday, April 30, the theater vaccinated only 18 individuals, although health officials had about 300 doses of Moderna allocated for the event.

Heading to a dinner downtown, Maria Mendoza declined a vaccination because she did not think it was necessary for her to get vaccinated at the moment. She said she would wait until the government makes it mandatory.

Some people walking past the theater said they had already been vaccinated while others were waiting to see if there were adverse effects.

When the vaccine shots first rolled out at the end of 2020, it was unimaginable that so few people would take advantage of available doses. People were so desperate for a shot that they refreshed web browsers looking for available appointments, drove to Phoenix or volunteered for eight-hour shifts at clinics, hoping enough vaccine would be left over at the end of the day that they could get a shot.

State records show that as of Monday, May 10, nearly 40% percent of Pima County residents had received at least one shot and more than 349,000 people were fully vaccinated. But as vaccine production has ramped up, supply is now outstripping demand. Dr. Francisco Garcia, Pima County's medical director, said last month that county officials are working four times as hard for every vaccine delivered, so the county was turning to mobile clinics in places such as the Fox Theatre, along Fourth Avenue, YMCAs and even local casinos.

"We know that a lot of people are not actually truly resistant, but are just hesitant. They're waiting to see how the dust settles," Garcia said. "We're hoping to make vaccine opportunities so ubiquitous throughout our community, whether it's on Fourth Avenue, whether it's in some of these parts, whether it's at a fixed site. We're trying to make it so damn ubiquitous, that essentially you fall into a vaccination needle without much effort. If we can decrease those barriers for those folks for whom these are obstacles, I believe that we will continue to make progress."

Overcoming vaccine hesitancy is not unique to Pima County. While recent polling varies depending on how questions are asked, a recent survey by CS News/YouGov suggested that 18% of those asked said they would maybe get a vaccine, while another 22% said they would not get a shot.

That reluctance, in turn, is slowing efforts to reach so-called "herd immunity" across the nation and in Pima County. Health officials estimate that roughly 75% of the population needs to get vaccinated to reach a level where the virus can't find new hosts to continue its spread.

Dr. Richard Carmona, the former U.S. surgeon general who has been leading the University of Arizona's coronavirus re-entry effort, said that unless more people get shots, the virus will continue to circulate as well as mutate into new variants, some of which may prove more dangerous and resistant to vaccines.

"The fact is the longer this virus is alive around the world the more it's going to circulate. The more it will mutate, and eventually will mutate to a virus that could cause some significant problems," said Carmona. "There is a scientific reason that we want to encourage the whole world to be vaccinated, and as a humanitarian issue as well. But for the self-preservation of mankind, everybody needs to get vaccinated."

Most of the people who came for a vaccine at the Tucson Chinese Cultural Center on April 29 were seeking their second dose of the Moderna vaccine.

Many said they lived nearby and since the mobile site required no appointments, it was easy to get vaccinated after work or school.

Lizbeth Bueno and Raul De La Rosa, 39 and 45, said they did not have any doubts about the vaccine, but had waited for a place where they could get easily vaccinated.

Bueno, who works at the Guadalajara Original Grill on Prince Road, said her manager informed them the Tucson Chinese Cultural Center would be offering vaccinations, and "many of us came from work."

She also passed on the location to other people she knew, who in turn passed it on to people they knew.

While the couple were not hesitant to get vaccinated, they do know people who continue to have concerns about "secondary effects" of the vaccine. Bueno said her friend has concerns about the ability to conceive after vaccination, and De La Rosa said some had concerns about how sick they would be after getting vaccinated.

Bueno and De La Rosa both said they would not have gotten the Johnson & Johnson vaccine had it been offered to them as their first shot, citing the recent pause of the vaccine as a concern. The vaccine's distribution was halted as health officials studied a rare side effect involving blood clots in women between the ages of 18 and 49.

Even though the CDC and Arizona Department of Health Services has resumed the use of the Johnson & Johnson vaccine, concern about the potential side effects of the vaccine continues to linger.

At the Chinese Cultural Center clinic, executive director Susan Chan called out on several occasions, asking if anyone would be willing to get the Johnson & Johnson vaccine, with few takers. Chan said although 200 Johnson & Johnson vaccine doses were allocated to the mobile site for the day, only seven people volunteered to take it. But Chan estimated that roughly 500 people at Thursday's clinic were returning for their second shot of Moderna.

Hieu Nguyen, 46, waited in line with his wife to receive his second shot of Moderna and brought along his neighbor to get vaccinated and help translate for him. Nguyen was one of the few who said he would take any vaccine offered to him.

"I do not have a preference," said Nguyen. "Everyone should take it. I would take everything."

However Nguyen said his neighbor was not as willing to receive the Johnson & Johnson vaccine.

For the month of May 2021, the state expected 15,800 doses of the Johnson & Johnson vaccine. Despite the hesitancy regarding J&J and the concern of vaccine wastage, Arizona Department of Health Services Director Dr. Cara Christ said vaccines like Moderna and J&J are better suited for mobile sites as they have a longer storage time frame and come in smaller multidose vials than Pfizer. The Johnson & Johnson vaccine can be stored in a regular refrigerator for up to three months, according to the CDC.

Christ said as a woman between the age of 18 to 49, she would take the Johnson & Johnson vaccine had it been offered to her as her first and only dose.

"I would get the Johnson & Johnson if that was the vaccine administered, or offered to me, and I was unvaccinated," Christ said during a recent press briefing. "I'm not one that wins the lottery. It's a really, really small risk, and I would recommend getting the Johnson & Johnson."

She would also recommend the Johnson & Johnson vaccine to her patients.

"I would advise a patient of mine: 'You're at higher risk for getting blood clots if you get COVID-19, than you are from getting a blood clot from this vaccine,'" said Christ. "Hearing those types of facts from your healthcare provider who is actively encouraging you to get vaccinated."

Christ believes allowing more local doctors and healthcare providers the chance to offer vaccines will be a "big help" in addressing vaccine hesitancy.

This month, the state began allowing providers registered with ADHS to order vaccines directly from the CDC without needing an allocation from a county health department. Almost 1,200 providers statewide are set up to order vaccines through ADHS. Some providers may have already received a vaccine allocation from their local health departments, but the change would make others eligible to receive vaccines for the first time.

Each registered provider will be able to order up to 200 doses of Moderna during a two-week period, but larger orders would be permitted for special events.

"Based on our community listening sessions, people indicated that a recommendation from their healthcare provider would be one of the things that would drive them to get vaccinated. So they trusted their health care provider and then those that they personally knew who had already gotten the vaccine," said Christ. "We do believe that if somebody is there on their annual checkup and it is recommended by their healthcare provider and that healthcare provider can answer questions that that individual may have about: How safe is the vaccine? What would the side effects be? What are the risks associated with it? A lot of people have very specific medical conditions that they want to know how the vaccine is going to impact that or how COVID is going to impact that."

Christ hopes the greater accessibility of vaccines would mean the state gets closer to herd immunity by the end of summer. However, reaching herd immunity requires vaccinating children under 18, who make up more than a quarter of Arizonans. Until a few days ago, the Pfizer vaccine was the only vaccine authorized for use on those 16 and older; earlier this week, the FDA granted emergency use of the Pfizer vaccine for children 12 years and above. Christ estimated that would make another 320,000 to 400,000 Arizonans eligible for vaccination and improve the sprint toward herd immunity.

Christ said vaccines are the best tool to avoid another surge in cases as other states are seeing.

"Hopefully we're on a plateau," Christ said. "That may increase, (we) may have more cases, but people aren't necessarily being hospitalized and dying from it. But we still could be facing another surge and that's what we're watching for every day."

As the rate of vaccine administration declines in the state, the number of COVID-19 cases have essentially plateaued since late March.

While more than 42% percent of Arizonans have received at least one dose of the COVID-19 vaccine as of Monday, May 10, the rate of infection was on a slight rise until the week ending May 2, when cases dropped for the first time since the week ending March 21, according to Dr. Joe Gerald, an epidemiologist and professor in the UA Zuckerman College of Public Health who has been tracking the virus for more than a year.

Gerald reported that with 4,946 people tested positive in the week ending May 2, meaning that 68 Arizonans per 100,000 residents tested positive. The state hit a low of 38 cases per 100,000 people on Sept. 8, 2020, between the summer and winter waves, and a low of 54 cases per 100,000 people on March 23 following the winter wave, with cases on the rise since then.

"Case rates will likely remain 'stuck' above the threshold differentiating substantial and moderate risk, 50 cases per 100K residents per week, for the next four to six week owning to more transmissible variants and continued normalization of behaviors," Gerald wrote in a May 7 report summarizing the latest status of the virus.

Gerald noted that Arizona's seniors now have the lowest rate of infections, at 26 per 100,000 among residents 65 and older, while the highest rate is among people 15 to 24 years old at 111 per 100,000.

He added that officials estimated 73 people died after contracting COVID in the week ending March 28, making it the first week with fewer than 100 deaths since October. The week ending Oct. 4 saw the fewest number of deaths related to COVID between the summer and winter surges, with 51 deaths.

But the number of Arizonans who have been hospitalized since Jan. 11, when Arizona hit a peak of both general admission and ICU beds. A total of 1,183 ICU beds were in use, compared to 457 in use by non-COVID patients, and only 8% percent of ICU beds available were available on that day. From early December to the end of January, Arizona had fewer than 10% of ICU beds available. Since then, ICU beds used by COVID-19 patients declined, and from about mid-March to the end of April stayed at around 10%, increasing by 1% through April into May.

Phillip Bullington, 31, a doctoral student in the UA's Nurse Anesthesia program, volunteered at a recent vaccination event. He worked as a nurse prior to beginning his doctoral project and has experience dealing with people who are severely ill, but what he experienced as a student registered nurse anesthetist in the ICU during the pandemic was beyond his expectations.

"We never really expected the way everything happened and then it just got crazy," recalled Bullington. "Where there's people on ventilators just taking up all the ICUs. We're turning other floors into ICUs and we're running out of places for patients to go. And then they would get sick, but they were healthy enough that they would still live for a while, but they weren't getting better. So just a pile of people who would get more sick and there was nowhere for them to go."

While Bullington says things are better, he thinks the situation could return to how it was during the height of the pandemic.

"It could always still go back the way it was," said Bullington. "With the new variants, I don't think there's any reason that it's completely over."

For Bullington, getting vaccinated is the "safest course of action."

"It's not a live virus, you can't get the virus from it. So it's better to be safe to be vaccinated than to take the risk of getting it or giving it to your family or your grandparents or your kids," Bullington said.

Bullington volunteered to assist with vaccinations at a clinic run by the UA College of Nursing faculty. Led by UA clinical assistant professor and program administrator of the Nurse Anesthesia Specialty Kristie Hoch, volunteer certified registered nurse anesthetists (CRNAs) and student registered nurse anesthetists (SRNAs) administered vaccines to people at the drive-thru.

For around 150 years, CRNAs have been ensuring the comfort of their patients, normally preparing patients for anesthesia before surgical procedures, said Hoch.

"We ensure patients are safe and comfortable during their anesthesia and this piece for us is part of ensuring our community is safe," said Hoch, referring to vaccinations as part of that work.

Since the onset of the pandemic, CRNAs have found themselves outside of the operating room.

"We've been called to take care of patients who are acutely and chronically ill with COVID," said Clinical Assistant Professor at the College of Nursing Charles Elam, who said he along with his partner were consulted to manage acutely ill COVID patients in Green Valley. They were tasked to install central lines, big IVs that go into the neck or chest, or arterial lines that go into the artery as well as managing ventilators and sedation for patients.

"This was above and beyond what we typically do, but because we are airway experts we were called upon and stepped up to do what we needed to do," said Hoch.

Hoch, who is also a member of the American Association of Nurse Anesthetists, said the event not only serves the community, but also honors the memory of her family members who passed away due to COVID-19.

"My father-in-law and brother-in-law both passed away due to COVID-19 at the beginning of this year. To me, playing a role in the vaccine rollout is my way of honoring their memory and ensuring others do not suffer their fate," said Hoch. "It's heartwarming to see my students joining the effort. As ICU practicing nurses, they've seen the effects of COVID from the frontlines, and share my passion for putting an end to the pandemic."

Not only CRNAs but even physical therapists got caught in the eye of the pandemic.

Physical therapist Piper Daulton worked around 64 hours a week in packed ICU COVID units at Banner – University Medical Center Phoenix. Daulton, who works in the Trauma and Surgical ICU normally providing physical therapy to people who've had car accidents or received spinal surgery, volunteered for the Prone Team last April.

The Prone Team, a hodgepodge of different disciplines, including nurses, physical therapists, occupational therapists, and techs, came together to work specifically in the COVID ICU to turn patients on to their stomachs in order for them to breathe better, said Daulton. She explains how they would turn intubated patients onto their stomachs for eight hours then every two hours would turn their head and arms to prevent pressure sores.

Unlike other physical therapist colleagues, Daulton is a young, healthy 28-year-old, with no children, and no comorbidities (which would make it more likely for someone to be severely ill from COVID-19), so she felt she could volunteer to work in the COVID Unit.

"Not to say by any means, had I contracted COVID it wouldn't affect me or I wouldn't have lasting effects from it. Not at all, but it was just something, kind of a risk that I took, because I wanted to help these patients," said Daulton.

She remembers a particular COVID patient, a "younger gentleman," who passed away while on his stomach. His wife was able to arrive in time to say her last goodbyes, then they had to flip him onto his back when he was deceased.

"I'll never forget that. It's something that I'm happy that I was able to do, just to kind of put life into perspective, and to be with that gentleman and his last moments and for that family, but definitely that's kind of weighed heavy on me. It's hard to talk about. It's hard to think about," said Daulton. "No amount of schooling can prepare anybody for what us healthcare workers have gone through over the last year and a half."

On July 2, in the midst of the pandemic, Daulton's grandmother unexpectedly passed away from leukemia. Since then, Daulton wears a silver necklace with angel wings, a birthday gift her grandmother gave her. The necklace helped her get through the last year.

"Since July 2 I've had it on, and it just gives me some hope and peace knowing that she's proud of me," said Daulton. "She was a woman of faith and integrity and of science. She couldn't wait to get the vaccine."

Daulton is one of several Banner Health frontline medical workers featured in "The Things They Carry," a visual project highlighting them and the personal items they carry to cope during the pandemic, which launched on Sunday.

Inspired by Tim O'Brien's book, The Things They Carried, about soldiers in the Vietnam War and the unique things they carried during combat, the project will showcase a series of portraits, video interviews and emotional stories on social media during National Hospital Week, which runs Sunday, May 9, through May 15.

Others featured are ICU nurse Craig Rufener, whose silver Buddhist prayer ring etched with 82 microscopic words helped him endure grueling overnight shifts, and patient transporter Steve Stanek, who creates bracelets from guitar strings and gives them to patients having a tough day.

Daulton hopes people will get vaccinated, and said she convinced her elderly neighbors as well.

She told them, "'I can guarantee you, you will want to get this vaccine, as opposed to me having to turn you over onto your belly in the ICU,' and that kind of resonated with them. I was like please get it. If not for me, get it for your daughter, get it for your 3-year-old grandson that you watch every week."

Daulton hopes people will be able to put politics aside to come together and "listen to the doctors, listen to the science, get your vaccine and stay healthy."

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