By Howard Fischer
Capitol Media Services
PHOENIX -- Arizonans in the highest priority categories of risk or need could get their first doses of COVID-19 vaccine in two weeks.
But they won't be risk-free for weeks after that. And it won't be until summer or early fall before everyone who wants to get inoculated will be able to do so.
State Health Director Cara Christ on Friday laid out the preliminary schedule for when vaccines will be delivered to health care providers and others. She figures the first doses of the Pfizer vaccine could be administered as early as Dec. 15.
That first group, though, is going to be limited to about 383,750 people. That, said Christ, is what she figures Arizona will get as its share of both the Pfizer and Moderna vaccines -- assuming both are given final approval this month by the Food and Drug Administration for emergency use -- based on the fact that Arizona's population is about 2% of the nation.
And within that group, look for health care workers to be the first with their arms out, particularly those who are working directly with patients. They will get about the first 184,000, with another 70,000 for home health aides, nursing assistants and medical assistants.
After them come residents of skilled nursing facilities and independent and assisted living centers. That's another 122,000.
"We know that living in a congregate setting puts you at higher risk for severe outcomes,'' the health chief said. "And these are some of our most medically fragile individuals.''
Christ said she is hoping for a second batch of vaccines, in about the same number, about three to four weeks later. That, in turn, will allow her to get into all the second-priority people, including adults with high risk medical conditions living in shelters or other congregate living settings.
Then there are the teachers, about 146,000 of them, along with police, corrections officers and other emergency response workers. This group also includes others who work at schools including bus drivers, cafeteria workers and front-office staff that deal with children.
After that come workers for utility companies and then people in food industries including those at grocery stores and restaurants, transportation workers like those who drive trucks and buses as well as gas station employees.
Also in that second group are other "essential workers" which the state says includes everything from financial services to funeral home employees.
The next priority would be nearly 2.3 million Arizonans with underlying medical conditions like obesity, heart diseases and chronic lung disease. Then there are more than 1.2 million Arizonans older than 65 who, assuming they haven't fallen into one of the higher priority groups, will be next in line.
This category also includes those confined to prisons and jails. But Christ said that inmates who have underlying medical conditions may, on an individual basis, be moved into a higher category.
That leaves everyone else as supplies become available -- and as people choose to get vaccinated. Christ said that even with a public relations campaign aimed at those who appear most hesitant, she knows there will be those who refuse.
And then there are those for whom the vaccine is not yet recommended due to lack of testing on those groups, including children and pregnant women.
All this assumes that the system of delivering and administering the vaccine works as planned.
There are technical issues.
Pfizer, whose vaccine is expected to be approved first, has some specific storage and shipping issues, particularly with the requirement for sub-zero temperatures.
It starts with anyone who wants a share having to be able to accept a minimum of 975 doses per order, at least at first.
"It will be shipped in a thermal box with dry ice,'' Christ said, with the ability to recharge it. The good news, she said, is that means it can be shipped to providers who don't have cold-storage freezers.
And if nothing else, Christ said, the containers should keep the vaccine at the necessary temperature for up to 10 days.
For those providers who can't handle that many doses, Moderna is making its version available in lots of a minimum of 100. And Christ said these can be kept in a regular freezer if not administered within 14 days.
But there is something common to both: Each requires two doses, within either 21 or 28 days apart depending on the vaccine, to be fully effective.
"So while some protection will be obtained two weeks after the first dose, full protection will not be achieved until one to two weeks after the second dose,'' Christ said. "So it's really important that everyone continue taking precautions even after being vaccinated to ensure that everyone is protected.''
She said procedures are being set up to ensure that people come back for the second dose.
In fact, Christ said, when the manufacturers ship the vaccine they are providing a complete kit, with syringes, personal protective equipment -- and even reminder cards to give to patients. And people can make the appointment for the second dose at the time they get their first one.
But here's the thing: Even after everyone who wants to be inoculated is served, that doesn't end the matter.
"What we don't know is how long that immunity lasts,'' Christ said.
She said it could end up being a situation like the flu where people have to get revaccinated on a regular basis, or whether it will be like the measles where there is a need for a "booster'' after a certain period of time.
"Those kind of studies will still be ongoing,'' Christ said.
The other side of the question goes to those who refuse to get inoculated.
Christ said the state has no plans to force the shots on anyone. But she said that employers, particularly those whose workers deal with the public -- and especially those who are vulnerable -- are free to impose such a requirement.
Cost is not going to be an issue.
The government is providing the vaccine without cost to those who agree to administer it. And she said that insurance companies have agreed to waive any out-of-network deductibles as to what providers charge for giving the shots.
Christ did not answer questions about when, if ever, she expects to have 70% of the Arizona populated inoculated. That is what some scientists consider the minimum level to prevent an epidemic, with even higher participation necessary for "herd immunity.''
To date nearly 6,900 Arizonans have died from COVID-19, with more than 352,000 cases reported. The actual infection rate may be higher since it does not include people who had no symptoms and did not seek medical care.