It’s Time to Nail Down Arizona’s Plan to Vaccinate Elementary School Kids… Now

Now that Pfizer has turned in their emergency use authorization application for their vaccine designed for kids between 5 and 11 years old, it’s crunch time to finish figuring out how we’re going to vaccinate kids fast next month. FDA’s advisory committee meeting is October 26th and CDC’s advisory committee is on November 2nd and 3rd, so it looks like we’ll get the green light on November 4.

This Pfizer pediatric vaccine is 1/3 of the dose that’s in the adult Pfizer vaccine but is otherwise the same. It’s coming in 100 dose packages (10 vials with 10 doses each), which is convenient. It’s still unclear whether doctors can spilt adult doses into thirds for kids. I haven’t been able to find out whether and how many pediatric vials will be ready by early November, so finding out whether adult Pfizer doses can be divided in thirds is important (hopefully FDA authorizes that practice). Being able to draw up pediatric size doses from adult vials will be absolutely critical if the supply of pediatric vials is inadequate or interrupted.

Note: While the Pfizer pediatric vaccine will initially be stored and transported at ultra cold temperatures (-90°C and -60°C) the vaccine can be stored at more reasonable temps for up to 2 weeks (before mixing) [ between -25°C and -15°C].

There are several models for getting kids vaccinated. The most desirable is for kids to get vaccinated at their medical home, like their pediatric office, community health center etc. Nationally, 70% of providers that are enrolled in the Vaccines for Children program are also enrolled to provide the COVID19 vaccine to kids. The ADHS hasn’t disclosed what percentage of VFC providers are enrolled in the COVID vaccine here in Arizona.

Whether pediatric offices (whether VFC providers or not) will have the resources and staff to get kids vaccinated fast is an open question. This is a very busy time of year for them and many are already understaffed. For those reasons, it’s important to leverage pharmacies and school and off site community clinics as distribution points.

Pharmacists in Arizona can administer any CDC recommended vaccine to kids 13 years old and up. They can also administer CDC recommended vaccines to kids between 6 and 13 years old with a prescription. But, a ‘Standing Order’ from the county health department can substitute for a formal prescription. [See ARS 32-1974 for the scope of practice for pharmacists re vaccines].  State law allows pharmacists to administer influenza vaccine to kids 3 years old and up without a prescription.

Note: A Standing Order can be used to authorize a pharmacist assess a patient’s immunization status and administer vaccine using a protocol approved by a qualified prescriber.  Standing orders enable assessment and vaccination without a clinician examination or a prescription from the provider that issues the standing order.

In addition, ARS 32-1974(E) says that pharmacists can administer vaccines to anybody regardless of age during an ARS 36-787 public health emergency (which we are still in). That means that we can definitely use pharmacists to roll our COVID vaccine to all kids 5 years old and up, supplementing the vaccination that’ll will be happening in pediatric offices, community health centers and other clinics.

On the other hand, pharmacies have been super-busy with Pfizer booster shots and influenza vaccine in the last couple weeks. While the demand for Pfizer boosters will likely want at some point in November, the Influenza vaccine demand will remain brisk. Also, both Janssen (J&J) and Moderna have asked the FDA for booster EUAs (J&J is just another dose of the existing vaccine, Moderna is 1/2 dose of their existing vaccine). That authorization may come in at about the same time as the pediatric vaccine EUA for Pfizer, putting additional demand on pharmacies.

On top of that, Arizona pharmacies have been increasingly understaffed and many have been cutting back on the hours that they are open. Some patients are saying their medications aren’t being filled in a timely manner. It’s unclear how widespread the staffing issues are, but this article in the Arizona Republic by Stephanie Innes reports troubling problems that suggest pharmacies may not be a good Plan B site for vaccinations after all.

That brings me to using school-based and off site community clinics to roll out vaccine. It’s looking more and more like we will need community based clinics to get kids 5-11 years old vaccinated quickly in November. Because of the staffing issues and demand for boosters and flu shots at pharmacies, community clinics will be needed. The county health departments and/or the school districts will need to contract with community vaccinators to set those up.

The bottom line is that we need to get the plans in place now so that we’re ready for November 5 when it’ll be all hands-on-deck to meet the demand for getting elementary school kids vaccinated.

So far, we’ve heard very little from the Arizona Department of Health Services about what their plans are.

That needs to change, pronto.

November 9, 2021: Join Us at AzPHA’s Annual Awards Party!

Each year the Arizona Public Health Association has a special awards event in which we recognize people across Arizona who are performing extraordinary work to improve public health in Arizona
Join us for AzPHA‘s annual award event as we recognize Arizonans that stood up for truth, evidence, and good public policy during the pandemic
Tuesday, November 9, 2021

5:00pm – 8:30pm

University Club of Phoenix (Outdoors)

39 E Monte Vista Rd, Phoenix, AZ 85004

Tickets Sold Out!

Meet Our Awardees!
Tickets are only $40 and include hosted appetizers and 2 drink tickets for wine, beer or soft drinks
Note: This is a celebration, not a fundraiser, so we won’t be hitting you up for contributions!
Awards to Include:

Policy Maker of the Year

This award is given annually to an individual or organization that works to create policy that improves public health in Arizona. 

The Senator Andy Nichols Award

The Senator Andy Nichols Award honors those who have made outstanding contributions to public health throughout their career. 

The Cele Cohen Nursing Award

The Cele Cohen Nursing Award recognizes a public health or community health nurse who has made an outstanding contribution to public health in Arizona. 

The Elsie Eyer Commitment to Underserved People Award

The Elsie Eyer Commitment to Underserved People Award recognizes an individual or organization that has demonstrated a sustained effort in assuring the delivery of health services to underserved populations in Arizona.

The Harold B Woodward Award

The Harold B Woodward Award is given for work done for the advancement or betterment of the Arizona Public Health Association. 

The Lloyd E. Burton Scholarship

The Lloyd E. Burton Scholarship is given to a student enrolled in an undergraduate or graduate public health program at an Arizona university or college. 

Health Education Awards

Health Education Awards Recognizes the creation of outstanding health education or patient education materials. Award categories are Governmental and Nongovernmental.

New! Pete Wertheim Public Health Leadership Award

Pete Wertheim Public Health Leadership Award recognizes an individual who demonstrates exemplary leadership and goes above expectations to address public health needs or challenges and exemplifies innovative approaches to improving public health in Arizona.

Public Health Research Award

Public Health Research Award This award recognizes an individual or team whose research contributes to the advancement of public health science and/or practice in Arizona.

Corporate Public Health Service Award

This award may be presented annually to a company or organization which makes a significant contribution and/or innovation to public health in Arizona. Eligible recipients are health or non health related nonprofits or for profit companies or organizations.

State Health Department Releases a List of Zip Codes That Have Been “Disproportionately Affected by the Enforcement of Arizona Marijuana Laws”

Agency Fails to Release their Methodology (at Least So Far)

When voters approved the new Adult Use Marijuana law last November they required the ADHS to establish a social equity program that would provide an opportunity for people that live in areas that have been “disproportionately affected by the enforcement of Arizona Marijuana Laws” an opportunity to qualify for a license to run a marijuana store (all the other stores are converted medical marijuana dispensaries).

In total, the ADHS will be issuing a couple of dozen additional marijuana licenses to persons who qualify under the social equity program.

The language that the voters approved told the agency to give preference to person that live in areas that have long suffered from over-policing and over-prosecuting for possessing small amounts of marijuana.

Last Friday, ADHS released the set of Zip Codes that they believe qualify as having been over policed and over prosecuted. Interestingly, they didn’t provide a map or disclose the criteria that they used to make the decision. Puzzling why they would release the list with no description of the methodology or data sets that they used.

For me, this is an important development, because it’s the first time that I’m aware of that the State of Arizona has officially conceded that certain parts of the state have been disproportionately suffering from over-policing and over-prosecuting, with important social justice consequences.

Dr. Gerald’s Weekly Epi & Hospital Occupancy Report: Transmission Remains High; Access to Care in AZ Hospitals Remains Restricted

View the Full Report

Arizona continues to experience high levels of community transmission with case rates now plateaued instead of consistently improving. Test positivity remains stubbornly high reminding us that test capacity, accessibility, and/or uptake is inadequate to meet public health needs. 

With waning vaccine efficacy and a potentially short duration of acquired immunity, the unvaccinated cannot “free ride” on high levels of community immunity. Instead, they will almost certainly become infected. This means that persistently high levels of transmission, and more importantly hospitalizations, are possible for an extended time until the supply of unvaccinated, previously uninfected adults is exhausted.

Vaccination remains the most important public health priority to reduce transmission and severe illness; however, mask mandates, restrictions on indoor gatherings, and targeted business mitigations are still needed to reduce/control transmission in the short-run with the primary goal being to prevent overwhelming our critical care facilities and reducing pressure for vaccine-escape variants.

Recent reports indicate that vaccine immunity to infection falls against the Delta variant by 6 months. Accordingly, it is becoming more likely that the Delta variant could sustain forward transmission even in a highly vaccinated community without additional boosters or other non-pharmacologic interventions.

Because immunity against severe illness is much longer lasting, infections among the vaccinated will have less impact on individuals and communities. This provides hope of an end-game where we can (mostly) live with SARS-CoV-2.

COVID-19 hospital occupancy is slowly improving. Nevertheless, occupancy is likely to exceed 20% of all beds in the general ward and 25% of beds in the ICU for another week or so. Access to care will remain restricted; therefore, delays in elective (non emergency) procedures will persist in the face of staff shortages in inpatient and outpatient settings.

Weekly COVID-19 deaths now exceed 200 per week and will almost certainly reach 300 for the week ending September 5th and perhaps September 12th too before receding.

U.S. Treasury Department Scolds Doug Ducey for Using Federal Relief Funds to Discourage Schools from Requiring Masks

 Treasury Department Demanding Answers
Read the Letter from the Treasury Department to Ducey

Just when you thought you’d seen the limits of the governor’s poor decision-making, he goes a step further. Back in August, he went so far as to misuse federal funds to provide financial incentives for K-12 schools to ignore CDC COVID mitigation recommendations. In a second Executive Order, he offered $7K per pupil in federal money to families that live in districts following CDC mitigation measures.

Let’s start with the school bribery scheme.

In that E.O. the governor offers to increase per pupil funding by $1,800 per year for schools that ignore CDC mitigation measures (universal masking).

Now on to the scheme where parents get $7,000 ‘cash on the barrelhead’ if they live in a district that is following CDC mitigation measures and they don’t want to send their kid there because of that.

Fortunately, the U.S Department of Treasury has been keeping a close eye on Governors that are misusing federal funds, including Governor Ducey. Today, the Treasury Department sent Doug Ducey a letter telling him that spending federal COVID relief funds for things that discourage compliance with evidence-based solutions for stopping the spread of COVID-19 is not permissible. The letter closes by demanding that the Governor “… describe how the State will “remediate the issues identified with the two programs”.

Here is an excerpt from the sternly worded admonishment letter:

We are concerned that two recently created Arizona grant programs undermine evidence-based efforts to stop the spread of COVID-19. We understand that the State of Arizona has established a grant program for school districts with SLFRF funds that is conditioned on, among other things, the recipient school districts not requiring the use of face coverings during instructional hours and on school property.” In addition, we understand that the State of Arizona has established a school voucher program with SLFRF funds to provide up to $7,000 per student to families fortition or other educational costs at a new school that does not require face coverings if the students current school is requiring the use of face coverings during instructional hours and on school property.

The purpose of the SLFRF funds is to mitigate the fiscal effects stemming from the COVID-19 ‘public health emergency, including by supporting efforts to stop the spread of the virus.5 A program or service that imposes conditions on participation or acceptance of the service that would undermine efforts to stop the spreadofCOVID-19 or discourage compliance with evidence-based solutions for stopping the spread ofCOVID-19 is not a permissible use of SLERF funds.

Accordingly, Treasury requests that the State of Arizona provide a response describing how the State will remediate the issues identified with the two programs described above. Please submit your response to Jacob Leibenluft, Chief Recovery Officer at the Treasury Department, within 30 business days of receipt of this letter.

Failure to respond or remediate may result in administrative or other action, including as provided under Treasury’s Interim Final Rule.”

Ducey’s Childlike Response: Take Me to Court

In characteristic fashion, Governor Ducey dismissed the US Treasury Department’s demand that he remediate his harmful practice of bribing schools not to require universal classroom masking. His short statement back to Treasury was that he will not be responding to the letter, telling Treasury to take him to “court”.

That sounds silly, considering that all federal grants come with certain conditions, conditions that Governor Ducey has broken. Remedies for failure to comply with the terms and conditions of grants are usually administrative sanctions rather than legal ones.

In other words, since the federal government is a large distributor of funding to Arizona, a usual administrative remedy would be for the federal government to withhold additional federal funding until the state demonstrates that it will stay in compliance with future terms and conditions by remediating his past non-compliance.

School Bribary Funds Disclosed

On Friday, Yana Kunichoff from the Arizona Republic disclosed which Arizona schools received funds under the governor’s program that is now under federal scrutiny. More than $109 million in federal COVID-19 relief funds has been allocated to 98 school districts and charter schools under that program, which was only available to districts without mask mandates.

You can search for which charter school chains and school districts received the cash in Yana’s article: School funding: Which schools got money from Ducey’s COVID-19 program? One thing that you’ll notice right away is the enormous amount of money that went to charter schools, especially the BASIS Charter Schools and others like it.

Save the Date: Annual AzPHA Public Health Award Celebration: November 9, 2021

Accepting Nominations Now!

Each year the Arizona Public Health Association has a special awards event in which we recognize public health professionals and health care workers across Arizona who are performing extraordinary services to our community.

Please take a few minutes to share those stories and others so that we may recognize them at our 2021 Arizona Public Health Awards to be held Tuesday, November 9th from 5;30 – 8:30 pm at the University Club (39 E. Monte Vista Road) in Phoenix.

It will be an outdoor, happy hour event. Tickets will be $40 per person. Registration begins later this week!

Please take a moment to view our award  categories and submit your entries by October 15, 2021

Nominate Here!

Past AzPHA Awardees By Category

AzPHA Scholarship Award

Cele Cohen Nursing Award

Elsie Eyer Commitment to Underserved People (CUP) Award

Harold B. Woodward Award

HEMMY Award

Senator Andy Nichols Honor Award

Governor Ducey’s Decisions Increased COVID Death Toll

AzPHA Executive Director Editorial in the Arizona Daily Star

By Will Humble

610 days after the state’s first COVID-19 death, Arizona is tragically, incomprehensibly, and preventably approaching its 20,000th life lost due to COVID-19. 

The most devastating part of this horrible pandemic milestone: Many of these deaths, and the countless additional lives impacted by each of their tragic passings, could have been avoided had it not been for poor, misguided, and overly-politicized decisions by Governor Ducey and former Arizona Department of Health Services Director Cara Christ.

Their willingness to play political hardball with a deadly pandemic is nothing new, but it wasn’t always that way. For the first couple of months of the pandemic, their response was somewhat thoughtful and nowhere near the level of political gamesmanship that we’ve suffered since. 

The memory of Ducey’s initial mitigation measures — a successful stay-at-home order in March of 2020 and a later “pause” of business operations in June of 2020 as a summer surge brewed — feels like a fever dream. His willing collaboration with officials regardless of political party is now a distant memory as his lethal politicization of the public health crisis continues to cost Arizonans their lives.

As a public health practitioner with over thirty years of experience, I can’t underestimate the dangerous impact that the governor’s knee jerk decisions — most of which run counter to any scientific evidence — have had in our state. 

Instead of eyeing his next primary election and catering to anti-science politicos, we’re asking the governor to please step up, drop the partisan posturing, abandon his pre-existing unwillingness to use mitigation measures, and get to work to end the pandemic in Arizona once and for all.

Here’s the bottom line: we want Doug Ducey and his team to begin doing what President Biden has done from the beginning — guiding us out of the pandemic. What’s more: we’re willing to help. We’re facing complex problems that threaten not only the lives of Arizonans, but the stability of our economy and the safety of our schools.

Here we are, 610 days into the COVID-19 pandemic in Arizona, about to surpass 20,000 deaths, and our governor is more interested in posing in front of border fences and criticizing President Biden’s efforts to proactively address the pandemic than applying evidence-based mitigation measures that we know work.

Thankfully, we now know how to get out of the pandemic. Give cities and counties back their ability to implement masking and other mitigation measures.

Stop micromanaging the universities and community colleges and let them incentivize vaccination and have a reasonable student code of conduct that requires unvaccinated students to get tested weekly.

Take his boot off the throats of local school boards and allow them to use evidence-based practices like universal masking to keep students healthy and in the classroom this fall. Begin using evidence-based, targeted messaging to persuade Arizonans to get vaccinated.

We just need Ducey to find the courage and political will to get the job done.

Governor, respectfully, it’s time to start doing your current job instead of positioning yourself for whatever you see as your next posting. 

Nearly 20,000 Arizonans have died, and more will continue to suffer if you don’t put your partisanship aside. Your aspirations beyond the governorship can wait — the health and wellbeing of our state can’t.

New Cases Per Week Stop their Former Decline; AZ Crosses the 20,000 Deaths Threshold; Unvaccinated COVID Patients Continue to Pack Hospitals, Impacting Non-Covid Care

View This Week’s Epidemiology & Hospital Utilization Report from Dr. Gerald

This week Arizona crossed over the 20,000 COVID-19 deaths mark. This pandemic would always have taken many lives no matter what kinds of interventions that Governor Ducey and former Director Christ implemented. The fact that they were hostile to masking requirements (even preventing cities and counties, schools and universities from requiring masks) and were unwilling to do any mitigation in bars, restaurants and nightclubs led to Arizona’s lethal outcome.

Arizona is 6th in the nation in COVID19 mortality because of Governor Ducey and former Director Christ’s decisions. For example, Colorado and Washington State have similar populations to Arizona yet have only had about 7,500 COVID-19 deaths. The difference? They have thoughtful governors and health directors.

Some have suggested that Arizona has had such a lethal pandemic because we have a disproportionately high number of older persons per capita. This is FALSE.  After adjusting for age, Arizona has the 3rd highest per-capita death rate from COVID19, just under New Jersey (which experienced the first wave at a very bad time) and Texas, which, like Arizona, has a governor and health director that are hostile to all public health interventions.

Current Situation Report from Dr. Gerald:

Arizona continues to experience high levels of community transmission with case rates plateauing. The decline in cases per week over the last 2 weeks has stopped and we are now no longer decreasing. Test positivity remains stubbornly high reminding us that test capacity, accessibility, and/or uptake is inadequate to meet public health needs.

With waning vaccine efficacy and a potentially short duration of acquired immunity, there’s little reason to believe the unvaccinated can evade infection with the considerably higher risk of severe outcome it entails. See this article from The Lancet for details. This trifecta means that persistently high levels of transmission, and more importantly hospitalizations, are possible for an extended time-period until we’ve exhausted our supply of unvaccinated, previously uninfected adults.

COVID-19 hospital occupancy is slowly improving. Nevertheless, occupancy is likely to exceed 20% of all beds in the general ward and 25% of beds in the ICU for another week. Access to care will remain restricted even on the backside of waning COVID-19 case rates. Expect delays in elective procedures to persist especially given worsening staff shortages in inpatient and outpatient settings.

View The Full Report

New At-Home Antiviral Pill May Be an Effective Treatment for COVID19

Please Don’t Call It a Game Changer, It Isn’t. The Vaccines Are!

Merck said in a press release today that an antiviral drug that they’ve been investigating “… significantly reduced the risk of hospitalization or death at a planned interim analysis of the Phase 3 among non-hospitalized adult patients with mild-to-moderate COVID-19.”  They say that the investigational antiviral drug, called molnupiravir, cuts hospitalization or death by approximately 50%. The press release said that 7.3% of the 775 patients who received molnupiravir were either hospitalized or died (28/385) compared with 14.1% of placebo-treated patients (53/377); [p=0.0012]. No deaths were reported in patients who received the drug compared to 8 deaths in patients who received placebo.

The Phase 3 clinical trial was stopped early because the trial was approaching full recruitment of the Phase 3 sample size (1,550 patients) with more than 90% of the intended sample size already enrolled.

HHS has already contracted for 1.7 million courses of molnupiravir subject to the FDA giving emergency use authorization.

Here’s an article from Nature Structural & Molecular Biology that describes how the medicine inhibits viral replication preventing viral reproduction by causing lots of base pair mistakes which is called ‘error catastrophe’.

Editorial Note: While the results presented by Merck in their press release are impressive, these results don’t even come close to the protective effect that vaccines provide. Plus, vaccines prevent infection and transmission of the virus, while this drug only provides a treatment.

From a public health perspective, the vaccines are FAR superior. Additionally, over-promoting this drug (if it is given emergency use authorization) will give one more excuse to people that have been thus far unwilling to get vaccinated to skip the vaccine… as they’ll feel like this drug will provide a safety net under them if they get infected. In the mean-time, they’ll spread the illness to others.