Could Zip-Code Level Data on AZ Vaccine Rates Prove State's Disadvantaged Are Losing Out?

Feb 20, 2021

The former director of Arizona's health department, Will Humble, says zip-code level data on Covid-19 vaccination rates statewide would show low numbers for disadvantaged populations. But will the state release the information?  

ARIZONA EDITION, February 19, 2021


HOST (LOU GUM): This is Arizona Edition on KAWC. I'm Lou Gum.  

 

We're talking today about the COVID-19 pandemic - this time taking a look back at the response here in Arizona by state and local leaders, and health experts.  

 

My guest is Will Humble, Executive Director of the Arizona Public Health Association and director of the Arizona Department of Health Services from 2009 to 2015, a department he held various positions in beginning in the early 1990s. 

 

Humble gives a range of letter grades to the state health director, Dr. Cara Christ, and Governor Doug Ducey, for their response to the pandemic, and addresses the uneven distribution of resources across urban, rural, ethnic and economic divides. 

 

LG: Let's begin if we can, with, you have sort of an umbrella view of health care in the state of Arizona that many don't. I know this is kind of a broad question, but in general this past year if you were to tell the story of how Arizona responded to the COVID-19 pandemic, how would you begin? Can you put a narrative to it at all? 

 

GUEST (WILL HUMBLE):  Yeah, yeah, maybe I could put it in perspective of like a grading system. Let's see if that works. 

 

I mean, I would say the response was really an A in March and April and the very first part of May. And then the decisions started to deteriorate pretty badly. - Will Humble

So, I think the state government as a whole, did actually really well in March and in April and at the very first part of May in terms of the policy decisions that they were making, the executive orders that the governor was signing.  The allocation of resources that the CARES Act provided to the governor and also the resources that were given by the state Legislature to the state health department and to state government for the response. 

I mean, I would say the response was really an “A” in March and April and the very first part of May.  And then the decisions started to deteriorate pretty badly.  

 

For me, just observing this, the turning, the inflection point was really when then President Trump came to Phoenix and visited a Honeywell factory that had been converted to making N95 masks for health care and that was, when Governor Ducey, you know, heard that the, then President Trump, was coming, he quickly reversed an important executive order that extended the stay at home order to May 15th and essentially moved us out of that stay- at-home order very, very quickly in May. 

 

And I don't, I don't think that that in of itself was such a bad decision. But the bad decision was moving out of the stay-at-home order into a complete honor system with respect to mitigation measures. And so, if you remember, when May 15th came, bars, restaurants in nightclubs all were allowed to open up as well as all of the other, you know, services that were considered nonessential, or yeah nonessential at the time. And there was no enforcement, or any expectation really that anyone would do mitigation measures - distancing, capacity limits, face coverings. 

 

And so, we saw this tremendous rise in cases throughout May, and then began to see a hospital crisis in June, when just we were actually entering crisis standards of care in our hospital system at the very first part of July. And so, I look at it as a critical error that was made in middle of May that led to the middle to summer crisis, but then I would say that the governor and Dr. Christ redeemed themselves a bit at the very end of June when they recognized there was a crisis and closed the nightclubs and bars for about a six-week period through the summer, and had restaurants go to take out. 

 

If you were going to ask me where was the most critical mistake, what was the most critical mistake during the entire pandemic? And I have to say that it was the decision by the governor and director Christ to not do any intervention whatsoever right before Thanksgiving. - Will Humble

And that was actually a success story because we dropped cases by almost 80% in that six-week period. If your listeners will remember back, you know the late summer seemed like actually things were going to be OK. And, you know, schools were starting to go back in session. Community spread was really at a manageable level, not great but manageable. And then they made the same mistake again by not requiring, or not doing any enforcement, of the mitigation measures throughout the fall. 

And that's when we saw the steady rise in cases throughout September, October and into November. 

 

And then there was the, I would say the real crescendo moment, where if you were going to ask me where was the most critical mistake, what was the most critical mistake during the entire pandemic? And I have to say that it was the decision by the governor and director Christ to not do any intervention whatsoever right before Thanksgiving. I mean that was there all the models, all the predictive models were showing that we were going to go into exponential spread, that there was going to be another hospital crisis, that we were going to have untold numbers of persons dying of COVID-19 without an intervention being, you know, targeted at bars, restaurants and nightclubs. And they made the affirmative decision not to do that. And made their opinion clear. And the governor said, you know, we're just not going to do that intervention again. 

 

And that I would say was the biggest, the single biggest mistake throughout the entire pandemic, was the late November decision not to do anything about these closed indoor environments where people stay a long time, where alcohol is usually served, because those are the places that amplify this virus. We know that. 

And what we have done since seeing, is you know, well, I mean, we're at more than 15,000 deaths above the, and probably seven, 18,000 deaths above baseline during this pandemic, about a 30% increase in mortality through the course of the pandemic, uh, attributable to Covid-19. 

 

And obviously some of those, even with the best interventions around bars, restaurants and nightclubs, if we would have still of course had many people die of this illness, but not nearly the numbers that we have suffered and it's a direct, I directly attribute that to the fact that they just didn't deal with those indoor closed environments at the end of November, and never have. And there just has been really no enforcement of mitigation at any of those environments, and to me, that's the critical control point where the, you know, where I have to get my D minus on this pandemic. 

 

Yeah, look you didn't... You weren't there when the chips mattered in late November to make the tough decision to do some significant mediation in bars, restaurants in nightclubs. 

 

LG:  Well, some of the other issues, at least here in Yuma County, early on testing, was an issue, not enough tests, and then later that happened again with vaccines. Sort of a lag. 

 

The story you just told. Can you focus on the more rural parts of the state? What happens differently in areas outside of, say Maricopa County or Pima County, where there's a sort of massive healthcare infrastructure available?

 

WH:  Well, it, it's your right and it is. 

 

There's a long history in Arizona where the urban areas have the direct attention of the state agencies that control the resources. Part of that is because there's more healthcare infrastructure. Part of it, quite honestly, is because the media infrastructure is in the urban areas and they control a lot of what people see, hear, and read throughout the state. And so, it becomes, it tends to become, an urban focus when it comes to the media and we have a governor and a health director who primarily, I shouldn't say primarily, but have a strong proclivity to respond to media attention. 

 

When you see the attention focus on urban issues, the resources go there in part because of the media attention that is focused on the urban areas at the expense of rural people and rural parts of the state. - Will Humble

Governor Brewer was not like that. Governor Ducey is. 

And so, when you see the attention focus on urban issues, the resources go there in part because of the media attention that is focused on the urban areas at the expense of rural people and rural parts of the state. It's, it's not limited to Covid, it's been something that has happened in this state for a long time. 

 

When it comes to testing, you know I well, maybe you could tell me a little bit better about that Colorado River area in the Yuma region? 

 

Like, you know, I, I know that there were struggles with limited testing capacity as there was in the rest of the state, but I, I and I have heard in different regions the limitations. 

 

Here's the thing. The state focused on making testing a priority when it became a train wreck in June. I mean, for so long people couldn't find a test at all, and then the state health Department and the governor, remember Operation Catapult? Did you guys remember that word? It was, they really increased testing capacity by hiring contractors. Embry Women's Health was one of them. There were many others that set up testing stations in different parts of the state. 

 

But they didn't increase analytic capacity at the same time. I mean, if you're going to increase the number of tests, you've got to also at the same time increase the capacity to analyze those tests. And that was the big mistake that was made through the summer is Operation Catapult sure, more people got tested over the summer, but then the two labs, LabCorp and Sonora quest, didn't have extra capacity to actually analyze those tests. So, I'm sure it was the same thing in Yuma as the rest of the state where turnaround times were like 14 days.  

 

LG: Right. 

 

WH: Like you get tested, and, like, you're recovered fully, or in the hospital before your test, lab results come back.  

 

Well, okay, what that meant was that contact tracing had no value as a public health intervention because in order for contact tracing to work, you need to get the results in like 2 days. 

 

LG: My guest today is Will Humble, executive director of the Arizona Public Health Association and former director of the Arizona Department of Health Services. 

 

Coming up, we'll hear some of what it takes for local and County leaders to get the attention of state leaders and whether that's a holdover from pre-pandemic behavior. 

 

I'm Lou Gum. This is Arizona Edition on KAWC. We'll be right back. 

 

(MUSIC STINGER) 

 

LG: Welcome back to Arizona Edition on KAWC. I'm Lou Gum.  

 

We're assessing the state response to the COVID-19 pandemic with Will Humble, executive director of the Arizona Public Health Association and former director of the Arizona Department of Health Services. 

I want to go back to something you mentioned about, sort of, how rural areas are viewed. 

 

When there is a shortage of testing or a vaccine, or even in issues pre-pandemic, how does a city of 120,000 figure into helping the state improve its numbers in any specific area? 

 

So, when planners sit down at the state health department or in other interested organizations that, you know, primarily come out of Maricopa or Pima County, one gets the sense from our local leaders that they're always sort of reminding those organizations that their communities need help. 

You had some experience running the Department of Health. Is that accurate? 

 

WH: Yes, and it you know it depends on the mindset of the persons and the leadership in the agency.  

 

So, I came out of, I worked there for 25 years at the state health department, and those last six years I was in the director position, and because I had worked so closely with county health departments throughout my entire career, I had developed a well-established, sort of, way that I dealt with my job and setting priorities for the resources that we had at the department. And I was always, and I think all the county health officers would tell you the same thing, I was very focused, in particular, in rural parts of the state to make sure that we were keeping them front and center in our minds and when it came to resource allocation. And so I always listened very carefully to the county health officers, and in particular the rural county health officers. 

 

Because that's where I could get honest information about the decisions that we were making as an agency, and one of the things that when you're in that director job, you have to listen to your stakeholders, because sometimes your staff will tell you what they want you to hear rather than what you need to hear. And so only by listening to the rural county health officers, can you get a clear picture of how you're actually performing as an agency in terms of helping those rural areas. 

 

Only by listening to the rural county health officers can you get a clear picture of how you're actually performing as an agency in terms of helping those rural areas. - Will Humble

So, I always reminded my team to think rural first. Because, and another reason for that is that, you know, a Maricopa County Health Department as an example. Yes, they're underfunded. But when it comes to the amount of staff and the expertise that they have, really, it's the best in the entire state. 

And so, uh, I would urge my team to just focus on the rural counties because they're the ones who need your help more. Even when it comes to, like, expertise during a foodborne illness outbreak or things like Covid, for sure. Or H1N1. Because the rural county health departments are the places that really need that technical assistance most. 

 

So, I don't know. It's a long, rambling answer to your question, but to me that key is really listening to your stakeholders. And when it comes to your question in particular, really listen to your county health officers because they will, they're a very, I found over the course of the years, they're a pretty opinionated group and they will tell you what they think, and it's important to listen to them because most of the time they're telling you the truth and then you have to make adjustments to your staff and your resources to make sure that you're doing the best job you can for rural parts of the state. 

 

LG: And of course, you, as you say, there has to be an ear for it. And it, it just seems... 

 

For example, right now. The state gets criticized for low vaccination rates and a site opens in Phoenix where 6000 doses per day will be administered. I'm pretty sure Yuma County hasn't received 6000 doses this week. So its implications are obviously more than rural versus urban as well. Yuma is a minority majority community.

 

WH: Yeah. Yeah, well, one of the things I've been pressing for consistently for at least three weeks now is to get the state health department to release the percentage of eligible persons that have been vaccinated by zip code statewide. They have the information. They have the data. 

 

I think the critical control point is the appointment system that the state has created and the way they admit, the way they allocate vaccine and appointments in, in these, like almost like concert ticket way. - Will Humble

The appointment system that, you know, everyone has to use has the zip code field. We have census data for all those zip codes. We need that map so that we can see where the underserved areas are. And so, I've been pressing journalists actually, saying, hey, anyone that will listen. I talked to a journalist, I'm like, make sure you put in a records request to the state health department to get the distribution of zip code, the distribution of vaccine administration by zip code according to the eligible population. So that we can see where these underserved areas are. And the state health department will not release that data. 

Maricopa County has, and what they found in Maricopa is precisely what I knew they would see, which is that the lower income zip codes are vaccinated at a far lower rate than the higher income zip codes. 

 

Now why would that be? 

 

In the case of Maricopa, and we will get to Yuma in a second. In the in the case of Maricopa County, I think the critical control point is the appointment system that the state has created and the way they admit, the way they allocate vaccine and appointments in, in these, like almost like concert ticket way. Where you know they release 21,000 appointments on a Tuesday morning at 9:00 o'clock and all the appointments are gone by 9:39. That actually happened. AM. And so, anybody who has a job that requires them to be at work and they wanted to get a vaccine for their grandma, or Abuelita, guess what? By the time you came home from work, they were all gone. In fact, they were gone before your first morning break. And because it's there's no mobile option to it, you couldn't even do it on your cell phone in the break room or try to do so. 

 

There's a big disadvantage for people without flexible jobs. And then you consider the fact that you need a good Wi-Fi to do it. You need a, you need a computer because it didn't have mobile attached to it. 

And there's all these disadvantages. Or I should say advantages for wealthy people. And it reflects in the data that you see in Maricopa County, where lower income zip codes are vaccinated at a much lower rate for COVID-19 because they, in my opinion haven't had the opportunity to make that appointment.

 

And I am certain that the same thing is happening in the rural parts of the state, and in particular the rural parts of the state with lower income. 

 

What they found in Maricopa is precisely what I knew they would see, which is that the lower income zip codes are vaccinated at a far lower rate than the higher income zip codes. - Will Humble

LG: And we knew this even from data from low-income families struggling to keep their kids at home and get them online for school. 

WH: Yes, that's right. 

 

The Title I school areas had lower access to broadband. Those are the same families that are at a disadvantage from trying to get these vaccines. And so, I have been urging, and I'm not going to stop, and I doubt that... 

 

I don't think the health department is ever going to release that information. They have it, but I don't think they're going to release it because I think it's just too damning. 

 

I think it would show that the policy decisions that they had been making, the allocation decisions that they've been making for these two initial vaccines, have favored wealthy urban areas, and the only way to actually, definitively, tell the story is to get those distribution maps statewide. 

 

They have the information. They have the data. They are unwilling to release it, in my opinion, because it's going to show that the decisions that they have been making are disadvantaging rural and underserved parts of the state. 

 

LG: Just a couple of minutes left. Though I do want to ask you, do you see the Arizona Legislature taking any steps to address any of the issues we've talked about today? 

 

WH: No, no. 

 

They're there solely focused on the bills that, their bills, you know, that they've dropped. I mean that, I'm just telling you, they're interested in the bills, in their bills, getting then through their chamber, then switching chambers, getting the to the other Chamber. I don't think there's much attention being paid to the pandemic at, basically at all, in the state legislature. 

 

The bills that you do see down at the legislature that are getting traction are bills, for example, that prohibit cities and counties from putting in face covering ordinances. I mean that, those are the kinds of bills that you see coming, you know, through these committees. 

 

LG: Last question. You gave us a bit of a narrative on Covid. Do you see an end point? 

 

WH:  Yes. I think if we can get, well, I think the Johnson and Johnson vaccine will get authorized by the FDA on the 28, well I think the Commission will approve it on the 1st.  March 1st. And I think we could start to see shipments of the Johnson and Johnson vaccine by March 2nd or 3rd. 

 

If we can then get the Astra Zeneca vaccine authorized by FDA, as well as Novavax, then we will have an adequate supply to quickly vaccinate enough people to get close to herd immunity by 4th of July. 

But it hinges on these, these additional 3 vaccines, Johnson and Johnson, Novavax, and Astra Zeneca.  

 

They have the information. They have the data. They are unwilling to release it, in my opinion, because it's going to show that the decisions that they have been making are disadvantaging rural and underserved parts of the state. - Will Humble

The companies have been manufacturing during the clinical trials, so they do have product that's ready to go as soon as those vaccines are authorized. And if we can, if we can get those vaccines authorized, I think that we will have enough volunteers stepping forward to get vaccinated so life could be close to back to normal by 4th of July. 

LG: Will Humble, executive director of the Arizona Public Health Association, former director of the Arizona Department of Health Services, really great to have your perspective. You've given us a lot of information that we can take down other roads and learn more. 

 

WH: All right, my pleasure. Have a nice weekend. 

 

LG:  And that's Arizona addition for this week. The program is a production of KAWC, Colorado River Public Media. Questions or comments are welcome. Send them to news @ kawc dot org. You can also hear our latest interviews online at kawc.org and through the KAWC app.  

 

I'm Lou Gum. This is Arizona Edition on KAWC. Thanks for listening.