(upbeat suspenseful music) - [Lorraine] On Arizona 360, getting answers to more common questions about the COVID-19 vaccine.

- Technically you can go up to 42 days after the first dose before you get the second dose.

- [Lorraine] Plus a closer look at the Arizona National Guard's role in responding to the pandemic.

- I never had a vision of all 50 states declaring a statewide emergency at the exact same moment.

- [Lorraine] And challenges with getting the vaccine in rural communities.

- We've struggled with funding to be able to hold large vaccination events.

(upbeat music) - Hello and welcome to Arizona 360.

I'm Lorraine Rivera.

Thanks so much for joining us.

Our focus this week again turns to ongoing efforts to get Arizonians vaccinated against COVID-19.

To date at least 970,000 residents have received at least one dose of the vaccine, another 313,000 are fully vaccinated.

Combined, that's close to 1/5 of the state's population.

Demand for the vaccine is also coupled with curiosity.

We pose some common questions to Dr. Joshua LaBaer who leads Arizona State University's COVID-19 research efforts as director of its Biodesign Institute.

We first asked about the vaccine side effects.

- So the most common side effects of course are sore arm, right, in the site of where the vaccine went in, and some fever.

Sometimes people are fatigued particularly if they're getting their second dose.

They feel like they wanna sleep off the next day.

Symptoms are really over by within a day and a half or two days from the vaccine.

If people are getting symptoms beyond that, then they should look for other causes, because generally speaking, they're done in a couple days, and they're mostly mild.

We've not seen severe side effects or any severe outcomes from the vaccine.

- Now there's some question about whether or not the vaccines will ever mix if the first dose is Pfizer and then you go to Moderna.

To your knowledge, has that happened?

Or if it does, is it okay?

- For the most part, we're trying not to do that because the clinical trials are all based on testing two doses of a specific vaccine.

That said, there are people now been doing clinical trials to see if you can cross the vaccines but really would not recommend it.

And we're really waiting for the clinical trial data to see if they work well.

- The system seems to be running pretty efficiently when it comes to scheduling that second dose.

What's the timeframe that someone could actually elapse where they may not get it that exact day but perhaps the week or two following?

- Right, yeah, technically you can go up to 42 days after the first dose before you get the second dose.

There have not been any studies beyond that.

So we try to encourage people to get that second dose as close to the scheduled time as possible mostly because that's how the clinical trials were run and that's what we know about, but really there is some window there for up to 42 days.

- Now there seems to be some confusion with whether or not you've already had COVID-19 and then you have the option to get the vaccine.

What is your recommendation?

- Right.

Ultimately we all believe that it'd be best if everybody were vaccinated including those people who've had the virus.

Now it is certainly true that there's good evidence to show that people who've had the virus, particularly symptomatic virus, if you've had no symptoms or very mild symptoms, that's not as clear, but people who had pretty symptomatic disease, not necessarily hospitalization, but they felt lousy, those folks generally generate their own antibodies, they generate their own immune response and they're probably protected.

So from the perspective of just letting other people go first, it could make sense for them to wait.

They probably don't need it as much as those people who've never been vaccinated and never gotten the illness, but eventually we do want everyone to get vaccinated.

- What is the research telling you about whether or not this particular vaccine will last for the duration of this virus?

Or are we going to be doing this again in the fall like we do with the flu vaccine?

- Well, we don't really know yet of course because it's not been that long.

We don't think that this virus is like the flu virus.

The flu virus is a very clever virus that is constantly changing its disguise.

And so every year it comes back looking a little different from the year before.

And we have to update the vaccines every year to kinda keep up with all of its changed, how it changes its appearance.

That does not appear to be the case with coronavirus.

Coronavirus is not so clever.

It looks the same all the time.

And so we probably won't need to kind of re-up vaccines every year.

We just don't know how long it will last.

We do believe that it appears that these vaccines are doing a great job at preventing severe illness, and that by far is the most important thing.

- Any indication that this vaccine prevents against this variant of the virus that seems to be emerging?

- Yes, so there are a number of viruses, a number of variants that are emerging.

There's the UK strain and then there's one from South Africa called B1351 and then there's also a strain out of Brazil called P1.

And what we know is that although the vaccines are a little bit less effective against infection from those viruses, it still provides very good protection, at least the Pfizer vaccine and the J&J vaccine which have both been tested.

It still protects against severe infection.

So even in areas where those variants are endemic, not seeing hospitalizations, not seeing deaths when people are vaccinated.

And so the vaccines are still pretty effective even against those variants.

- Dr. Fauci raised some eyebrows recently when he said that he wasn't sure if this particular vaccine prevented an illness against people who might be asymptomatic, because there's questions, should you keep wearing your mask if you've already gotten both vaccine doses?

- In the state of Arizona, somewhere between 70 and 80% of our population has still not been infected or seen the virus yet.

So there's a lot of people out there who could still get infected and some fraction of those could get very ill.

So while we're still trying to get everybody vaccinated, we should still be wearing masks and still following the guidelines.

Even those people who've been vaccinated when they are around other people who have not been vaccinated should probably wear masks and protect themselves.

Now people who are vaccinated with other people who've been vaccinated can mingle freely and without masks, and they should be able to do whatever they wanna do.

It's really just when people who've been vaccinated are around people who've not yet been vaccinated, they should probably still wear masks at least until we get everybody vaccinated.

- Okay, Dr. Joshua LaBaer from Arizona State University, thank you.

- Thanks.

- Operations at the state's newest vaccination site kicked off this week at the University of Arizona.

Already a hub for hundreds of vaccines daily, but with the state's backing, officials hope to see capacity increase to 6,000 doses a day.

- When your place in line arrives, we urge you to get vaccinated.

These vaccines are the light at the end of the tunnel, and vaccines are one of the most effective public health tools we have for controlling diseases.

- Also on hand for Thursday's rollout, Major General Michael McGuire.

McGuire oversees the Arizona National Guard, a pillar of the state's response to the pandemic.

I spoke one-on-one with McGuire about its mission.

- [Woman] Car moving.

- [Lorraine] This site currently administers something like several hundred doses a day.

The expectation is to go into the thousands.

How likely is that?

- 6,000, 6,000.

- That sounds like quite a feat.

- It sounds like a lot.

It sounds like a lot.

When we started at State Farm, our objective was to start slowly, go with 800 a day.

And I think by the end of the first week, we were up to 4500 a day.

We're averaging about 9200 a day right now.

And if we had a larger volume of vaccine available, we could get to 12,000 a day.

This site is built out to do 6,000 a day everyday if we're running at 24 hours.

- There are no guardsmen here today but there will be soon.

What sort of role will they be filling when they are here?

- So typically at a site, we will work with the incident manager, in this case, the University of Arizona.

And if they have gaps in either data entering, any logistics support, or traffic control, we can fill them with really any soldier or airman.

If they have gaps in the need to either monitor folks post-vaccination or give vaccinations, just about 200 of our guardsmen that are on orders right now that have medical specialties.

They are also qualified to administer vaccine and do those types Of things.

- Okay, there is some concern that there are not enough to go around.

We could run out.

How do you manage that as the guy who's in charge?

- Well, we continue to work with the Department of Defense on the logistics side and with Dr. Christ on the health side to make sure that we're ordering proper amounts.

As you know, there was some really rough weather this week around the country so there was a delay in shipment.

I have gotten assurance from my logistics folks and from all the folks on Dr. Christ's team that the Pfizer vaccine we have ample supply until our next shipment is in.

I'm not confident right now where we're at with Moderna.

We are gonna make it at least through tomorrow, but there may be some interruption with the Moderna based on the missed shipment, but as soon as we get it back in, we'll get it up and running.

- Okay, this week, President Biden said by July, everybody who wants a vaccine should be able to get one.

Can you ballpark it here in the state?

- So I've been saying that our objective is to have 3 1/2 million which is about half of our state vaccinated by July 1st.

Right now at our current production schedule, our biggest challenge is gonna be getting out to the rural and tribal communities to keep them on pace which is why most of the uniformed guardsmen I'm gonna put out in the more austere and rural conditions.

You won't see them much in Maricopa or Pima County 'cause the communities have such a depth of resources to get things done.

And I'm confident that we'll make 3 1/2 million citizens or let 3 1/2 million have access to the vaccine by then.

And if demand exceeds that, we'll continue it through the end of September.

Again it's an all drive-through site but they have multiple lanes and multiple vaccine sites set up, five cars deep, three wide so up to 15 cars at a time.

- What else is happening behind the scenes that the average person may not realize?

- So I think the biggest thing that is probably misunderstood about the Guard is that we are very small.

7600 people is not that many.

But what we do is we bring a depth of knowledge for logistics, planning, and sustainment.

So like at this site, we help expand Pima County's already great footprint here to expand the hours.

- Has it been a heavy lift to have to shift course?

- It has been something we train for all the time.

We never know if it's gonna be a pandemic or an earthquake or a wild land fire or whatever.

Those types of missions still have the logistical backbone that needs to be supported, the sustainment, the feeding, the water, all the things that we train to do militarily when we put 13,000 of our brothers and sisters in arms on the other side of the ocean.

- Could you do it for the next year if you had to?

- We right now are on orders through the end of this fiscal year through 30 September, and then the federal government will make a decision about extension of the mission and the progress of the response to COVID-19.

And if they stand it down, I'm certain our community will be ready to fill in.

- You have decades of service in the Air Force.

And I know you say that you plan and you prepare and you train for this, but stateside, did you ever anticipate this sort of-- - No.

- Mission?

- I never imagined.

You talk about how we declare emergencies at the state level.

I never had a vision of all 50 states declaring a statewide emergency at the exact same moment.

And kind of in this position, what we've had to do as we've tackled COVID is kind of fight with what we've got in our local communities and in the Guard.

And I just couldn't be prouder of how all Arizona communities have stepped up and answered the call.

- All right, Major General McGuire, thank you.

- Thank you Lorraine.

- Days before meeting with Major General McGuire, Arizona 360 captured another aspect of the Guard's response.

It took us to Sahuarita, a town of about 30,000.

Since April, the Guard has maintained a steady presence there, doing its part to keep the community nourished.

- We gotta get the cold stuff in there.

- We gotta get the cold stuff in first if we can, the milk.

- [Lorraine] It's somewhat unique to see troops serving in this capacity stateside, but as the pandemic lingers on, citizens, soldiers, and airmen are regulars at Sahuarita Food Bank.

A couple of days a week, you'll find them packaging and distributing groceries and meals for families in need, or in this case, helping get a car back up and running.

- Well, if they weren't serving in this capacity here in Sahuarita, it's more than likely that these soldiers and airmen would probably be at a vaccine site somewhere or at a test site somewhere in the state.

- [Lorraine] "All mission is the result of the pandemic," says Sergeant Major Fidel Zamora, the senior enlisted leader of the Arizona National Guard.

- [Fidel] They're helping the operations go smoothly.

When I came in, I saw some traffic control.

They were actually putting the boxes into the vehicles of the folks that are coming through, and they're running back inside and getting the shopping carts filled back up and for the next vehicle to come through.

- [Lorraine] The town of Sahuarita had a need that this cadre could fill.

For years, the Food Bank and Community Resource Center have operated out of The Good Shepherd United Church of Christ.

The majority of volunteers are senior citizens, a vulnerable population that had to scale back their generosity.

Meanwhile, the 300 plus families that relied on these services grew, says Carlos Valles, the Food Bank's executive director.

- Last year during the pandemic, our numbers increased 150%, certain days up to 200%.

We've been operating out of a church, that primary purpose of a church is a church, and it's been difficult.

So we're extremely excited that we're gonna have a dedicated facility where we can operate to its fullest potential.

I'm excited.

I'm excited that we're gonna finally have our own home.

- [Man] Three, two, one.

(people clapping) - [Lorraine] After years of planning and fundraising, the Food Bank is coming into its own with a 14,000-square foot facility behind the church, and it will need a different kind of army to support it.

- All these soldiers and airmen that you see at food banks, test sites, vaccine sites, have a military job occupation that they need to be skilled in.

Some are fuelers, some are infantrymen, some work in civil engineer, some are medical, and those skills need to be, they need to be professional skills when we send them overseas to do their job.

- [Lorraine] It's a reality of their service.

This week, the Arizona National Guard deployed a unit to the Middle East.

Send-offs like this one are a reminder that for these men and women, serving on the front lines often places them thousands of miles from home and their departures leave a void that leaders hope their neighbors will fill.

- This is a whole community approach.

Everybody's gotta get involved.

The National Guard has another mission.

They're very happy supporting this mission no doubt, but we are the primary combat reserve for the United States Army and the United States Air Force, so we still have the mission of defending the nation.

And we will continue to do this but we need to start thinking forward so that those soldiers and airmen are prepared to go do that mission when they're called to do it.

(soft upbeat music) - About 5% of the state's population lives in rural Arizona.

Getting the vaccine to those communities or to tribal nations has been a challenge.

Tony Paniagua takes us to Cochise and Santa Cruz counties for the story.

- [Tony] Emily Harris attended the University of Arizona where she graduated in December with a master's degree in public health.

Even before then, she had a job in Cochise County.

- I'm the infectious disease program manager for Chiricahua Community Health Centers.

- And how long have you been there?

- I just started actually early October.

So it's been about four months, relatively new.

- [Tony] And what a time to begin her career, a worldwide pandemic affecting billions of people without enough vaccines to fight the infections at least currently.

It's been an intense introduction to her chosen profession.

- It's definitely a lot of curve balls thrown at you day by day.

Information is always changing, challenges are always coming up, and everyone is just kind of rolling with the punches as best as they can.

They have a pretty great team supporting me so I'd say it's been going pretty well so far.

- [Tony] At Chiricahua Community Health Centers where she works, staff have been able to vaccinate close to 80% of their workforce and hundreds of patients.

The company has 11 clinics, four pharmacies, and five mobile units in Bisbee, Douglas, Willcox and other communities.

They were forced to stop vaccination events for the public due to a lack of a lot of doses and financial support.

- So right now, like I said, we are able to administer about 600 to 610 per week.

We've struggled with funding to be able to hold large vaccination events like ones that we've done on the weekend where we can vaccinate over 300 people in a day.

So we are struggling to meet the demand.

- [Tony] And her predicament is part of a common scenario across the state.

Jeff Terrell works in Nogales, west of Cochise County, which is desperate for more vaccines.

- We have reached out to the state.

I have put challenges out to the state.

I've challenged them to give me more vaccines.

I will get them in their arms.

We've asked for more.

We've had our board of supervisors advocating, we've had businesses down here advocating for more vaccines, and unfortunately there's just not enough available.

So we continue to advocate for more as every county is.

So as soon as we get them, we're putting them in their arms.

- [Tony] Santa Cruz County has around 47,000 residents.

About 2,000 have received both required doses of the vaccine, but officials would love to do more.

- I don't know if we're getting 10,000 a day but we're getting 10,000 a week.

We could get them in their arms.

We have the capability of ramping up several other pods and we do have people on standby as far as people that can vaccinate.

So we are ready to ramp up and open up more pods throughout the county to get the people vaccinated.

- [Tony] While the majority of Arizona's more than seven million residents live in the Phoenix or Tucson metropolitan areas, Arizona also has hundreds of thousands of residents in its other more rural counties.

These are often expansive and can encompass more territory than some states.

Arizona also has 23 federally recognized tribes, so experts say it could be difficult to coordinate between governments, agencies, and medical groups to get vaccinations into people's arms.

In addition, the current vaccines, Pfizer and Moderna, have to be kept well below freezing temperatures while being transported and stored.

Dr. Dan Derksen is a director at the Arizona Center for Rural Health at the University of Arizona.

- Help is around the corner.

And we're expecting before the end of the month the emergency use authorization for the single-dose Johnson & Johnson vaccine which has far less stringent cold chain and refrigeration requirements.

So that will be of a huge amount of assistance for these rural and frontier areas.

- [Tony] Because of its size and demographics, Derksen says Arizona faces some pronounced difficulties compared to more urban regions.

These include long distances between patients and their healthcare providers, elderly or poor residents without reliable transportation, limited access to computers or the internet, and barriers with the English language, or a lack of childcare.

As more people get vaccinated, there should be a decrease in residents who get sick which will relieve some pressure on the medical field, but experts stress that it's too early to let our guard down.

They recommend continuing to follow CDC guidelines to reduce the chances of infection.

- There is still quite a residual of the anti-vaccine movement.

We haven't seen that yet because the demand has far exceeded the supply, but that will come around because that still creates a pool of vulnerable individuals who either haven't had the infection or haven't had the vaccination that can still get COVID-19.

- Are you looking forward to, let's say, three months, six months down the road when things will have settled down somewhat?

- I think so, yeah.

Just being able to open up to a broader range of infectious disease.

We're currently also working on a project that tackles issues of infectious disease on both sides of the border because we are so close to Mexico in the state of Sonora.

So looking forward to that.

But I'm happy to be doing my part in COVID response and tackling the pandemic at hand right now as well.

- Across Arizona, select pharmacies have begun administering the vaccine.

It's part of a nationwide program with the CDC meant to increase access.

In addition to that, students and staff with the University of Arizona are also working to get the vaccine to underserved communities.

We learn more from Dr. Nicole Henry, an assistant professor at the U of A College of Pharmacy.

Have there been challenges with outreach given that traditionally you have older patients who are used to going to the pharmacy or their doctor's office to get a vaccine, and in this case, they're required to log into a website?

- Absolutely that has been a very large challenge for our population.

We do have a way that they can dial in and actually set up the appointment one-on-one with somebody over the phone and they can enter in their information online.

That process has been very successful.

As long as somebody does have a phone or access to email, they can register for the vaccine.

- You're also a professor.

How are you advising your students or pharmacists in general about best practices when it comes to having those conversations with people about who's eligible whether or not they can get one at that local drug store?

- Absolutely, so we have got some pushback where patients may or may not be really interested upfront for the vaccine, but we have been counseling them that the benefits do outweigh the risk.

It is something that is absolutely recommended by the CDC that somebody does obtain that vaccine.

Even if they do have multiple medical conditions, it's still better to be vaccinated and be protected from COVID-19 than to get COVID-19.

- One of the challenges has been reaching parts of rural Arizona.

As I understand it, there are mobile clinics that are in the process of rolling out.

How effective have they been thus far?

- Yes, absolutely, so our mobile clinics will be rolling out this week, and we are gonna be covering all of Maricopa County.

So we are super excited about that.

It's also a way that we can improve access for patients.

So when we are onsite, we can actually enroll them with the website at that time.

So since we're able to enroll them one-on-one, that does decrease some of those barriers as well.

- Can you give us some idea of how exactly they'll work?

I mean is it literally a bus that has qualified staff inside where you could go in and receive it?

- It really is.

It's a bus that's set up with medical equipment inside.

We do have a refrigerator to store the Moderna vaccine.

That's the vaccine we were approved for here on the College of Pharmacy Campus.

And we have trained personnel inside.

We also have a supervisor, a pharmacist, or a physician to oversee the patient after they've received the vaccine.

We do monitor them for 15 minutes if they don't have a history of allergic reactions just to be sure.

We have EpiPens on hand.

If they have had allergic reactions in the past, we make sure that we monitor them for 30 minutes.

- Dr. Henry, one of the concerns has been that though vaccines are free when you go to get one, you're asked about insurance.

Why is that?

And how are you managing the messaging in that case?

'Cause it could be discouraging if someone doesn't have insurance.

- Absolutely.

We do encourage patients that it is free for all.

We do need to try to bill their insurance and make an attempt at that at first before we can bill their HRSA program through the government.

- In general, it seems there have been conversations about how people are skeptical of the government wanting to inoculate people.

You're a pharmacist.

How do you have those conversations?

- Yes, absolutely, we've heard all sorts of things.

This is a government chip, it's going inside my body, I don't believe in it.

You name it, we've heard it.

Basically we have the one-on-one conversation with the patient.

We do involve the family member as well if that's an option and just have a discussion that the benefits outweigh the risk.

There's not a government chip inside this.

We are administering a vaccine that is life-saving in these populations.

It is absolutely recommended.

And by encouraging them that way and listening to their concerns, we listen to them, we go over each concern, really we've been able to motivate them to get their vaccine.

- How do you teach future pharmacists based on what you've learned through the COVID-19 pandemic?

Are there things that you wish you would have been doing sooner or things you can implement moving forward?

- I would say that it's best to make sure that the patient is heard and they can come up with their own decision about getting the vaccine.

So this is not something that's mandatory.

It's a shared patient decision-making process.

So I think that it's really helpful to teach students to treat patients like equals, to treat patients like it's you or I getting a vaccine.

If we're scared, we're not going to want to get it, right?

I mean we need to have somebody that's willing to listen to those concerns, break down those barriers, and really encourage them that we're healthcare providers, we're all in this together and they do need to get the vaccine to help bring hope back to humanity and have everyone be protected from COVID-19.

- Okay.

Dr. Nicole Henry from the U of A College of Pharmacy, thank you.

- Thank you so much.

- That's all for now.

Thanks for joining us.

To get in touch, visit us on social media or send an email to arizona360@azpm.org and let us know what you think.

We'll see you next week.

(soft music)