SUN CITY, Ariz. — The need for a Covid-19 vaccine is as urgent in Arizona as anywhere else. Numbers show that the coronavirus is spreading faster here than in almost any other state, and Arizona is home to a large number of older people who tend to be at higher risk of dying if they contract the virus.
But that doesn't mean vaccine doses are flying off the shelves. Instead, 4 out of 5 doses that arrived in Arizona by early this week hadn't been used, waiting for someone qualified to give the shots.
The halting rollout has sparked anger and disappointment nationwide, even as officials said there was still plenty of time to pick up the pace of vaccinations before they start for the general public.
At least in Arizona, one reason for the slow pace was frustratingly simple: Years of belt-tightening and neglect of state and local health budgets mean there aren't enough trained people to administer vaccinations, current and former government officials said.
"In our state, it's a skeleton crew by design," said Will Humble, executive director of the Arizona Public Health Association and former director of the state's Department of Health Services. He said a desire for low taxes and smaller government was coming back to bite residents of the state, which has a long history of conservative politics.
Maricopa County, the fourth most populous county in the U.S., with 4.5 million people, has gotten about 133,000 vaccine doses for its 125,000 front-line health care workers. But through this week, only about 44,000 people had gotten their initial vaccinations.
The snags are affecting a relatively small number of people eligible to be vaccinated now, so the impact may not be long-lasting. But they raise questions about the larger rollout that is still to come, and they risk damaging public confidence in the country's capacity to deliver shots quickly, especially after testing was delayed throughout the pandemic.
The job of vaccinating the public has fallen to the same county health departments and hospitals that have been working under the strain of the pandemic for 10 months. And there are only so many workers to go around.
"It's easy to say you should have 123,000 people through in one week, but we're also talking about the fact that these are people who are trying to service these hospitals, and these individuals administering the vaccines also have to medically be able to provide a vaccine," said Marcy Flanagan, executive director of the Maricopa County Public Health Department.
Maricopa County has set up five locations, or "pods," in parking lots throughout the county to give the injections. The five locations processed about 7,000 people Wednesday.
Flanagan said she expects to be ready to move more quickly when the state and the county move to the second group on the priority list, known as 1B. Statewide, 650 locations are administering vaccines in the 1A phase for front-line health care workers and long-term care residents, but they're not the large-scale sites that authorities plan to set up in the weeks ahead.
Lags in scheduling appointments have frustrated some people in the 1A phase. A health care worker in Arizona shared a copy of an email she got Dec. 21 saying she had been "confirmed eligible to receive a vaccination in this phase," but she didn't hear anything again until a week later.
The worker, who spoke on condition of anonymity because it's a sensitive issue in her workplace, said that she wasn't given a reason for the delay but that eventually she got a shot.
There's a separate process involving private pharmacy chains for long-term care facilities and nursing homes, and those vaccinations haven't always gone quickly, either. At Beatitudes Campus in Phoenix, a senior campus with 700 residents, only 38 residents and staff members were given doses on the first day of vaccinations this week; technicians planned to return the next day to continue giving doses.
Delays and snags have been reported in other states, and Trump administration officials this week acknowledged their disappointment in the rollout. They said Christmas and other holidays have caused delays, as have snowstorms and problems storing the vaccine doses at the required temperatures.
"There really has to be a lot more effort, in the sense of resources for the locals," Dr. Anthony Fauci, the government's top infectious disease expert, said Thursday on "TODAY." "We have to support the local groups, the states and the cities to help them to get this task done."
Fauci said the federal government should provide more resources to states and localities, rather than take over the effort entirely. Congress only recently approved $8.8 billion for vaccine distribution.
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Arizona could use the help. The state received more than 314,000 vaccine doses in December, but it had administered only about 57,000, or 18 percent, as of Tuesday.
"In our state, there simply isn't the staff to do almost anything," said Humble, of the Arizona Public Health Association, a membership group for people who work in public health. "They're not doing a great job now because they're so understaffed."
At the same time, the pandemic is worsening locally. The number of people hospitalized with Covid-19 in Arizona is at an all-time high, and intensive care units were 93 percent full Wednesday, also a record.
Dr. Cara Christ, director of the state Department of Health Services, said it would be a "monumental task" to vaccinate the entire state population over the coming months. "It's going to seem like it's moving very slowly," she said. "Everyone is figuring this out as we go."
Arizona's 15 counties are tasked with disseminating and administering the vaccine doses, but the state could step in. Christ said she would like to get more "cohesive information" out to residents.
"I do think that the local health departments need to have a say in terms of where those doses go. But what we're seeing is that it's making it difficult for Arizonans on how to identify where to get vaccinated," she said.
Gov. Doug Ducey, a Republican, issued an executive order Wednesday empowering the Health Services Department to "take possession of any vaccine allocation and reallocate it to provide statewide coverage" for faster distribution and administration.
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An unknown factor is how many people eligible in the 1A phase are refusing to get shots. At a fire station in Maricopa County, half the firefighters were forgoing immediate vaccinations, said a person who spoke on condition of anonymity. Local officials said they would know more next week when they see how many people have declined appointments.
Private hospitals and health care providers have been adding resources. Banner Health, a large medical network based in Phoenix, has launched a website with information for people seeking vaccinations, and Becky Armendariz, a spokesperson, said it has nearly 3,000 appointment slots a day, with eligibility determined by state and county guidelines.
Sonia Singh, a spokesperson for the Maricopa County Public Health Department, said those giving the vaccinations are trying to do two things at once: run the 1A phase for front-line health care workers and plan the much larger 1B phase, which in Arizona will include anyone age 75 or older, as well as essential workers.
"We wish the vaccine was something we could just ship to people's homes, but this is the time that we need people to take a deep breath," Singh said. "Be patient with the process. When it's your turn, you'll know it's your turn."
Vaughn Hillyard reported from Sun City. David Ingram reported from San Francisco.