Frontline healthcare workers and nursing home residents in Arizona this week start receiving the first doses of a highly effective, safe vaccine against COVID-19.

Providing they live in Maricopa or Pima counties.

Rural counties like Navajo and Apache counties will have to wait until Christmas before healthcare workers and nursing home residents start the receiving the first batch of vaccines. The lack of mass-vaccination capacity and the difficulties in handling the delicate Pfizer vaccines have delayed the rollout in rural counties. The vaccine must be stored at temperatures of 80 degrees below zero and used quickly once it’s thawed.

Early this week, state health officials said they should receive 58,000 doses of the Pfizer vaccine on Dec. 15 or 16, with 47,000 doses for Maricopa county and 11,000 to Pima account — reserved for high-risk health workers.

Navajo County anticipates receiving its first batch of vaccines until Dec. 21 or 23, a life-saving Christmas present.

The county has about 1,900 front-line medical workers who should get their shots before the end of the month. According to county officials.

Nursing homes throughout the state are working with various pharmacy groups and should also get their vaccines before the end of the month.

The county’s also working with 17 different community and healthcare groups to set up vaccination sites throughout the county, including drive-through the sites. The vaccine will be free, even for those without medical insurance.

Health officials hope that the 383,000 doses heading to Arizona by the end of December will be enough to protect almost all front-line medical workers and the state’s 27,000 nursing home residents and staff. COVID-19 has proved devastating to nursing home residents, which account for roughly 40% of the deaths from the pandemic so far. The vaccine requires two doses three weeks apart. The first dose reduces the odds of infection by about 50% and the second by 95%. So the state hopes to vaccinate 200,000 people by the end of the month.

“We are thrilled to see the vaccine here in Arizona,” said State Health Director Dr. Cara Christ. “The Department and the Vaccine Task Force have been working for months to make sure the vaccine is efficiently distributed throughout the state once shipments came in. While vaccine distribution is underway, it’s critically important that Arizonans continue to follow health and safety precautions to fight the spread and protect one another. This is not the time to let our guard down.”

The vaccine comes as the virus rages out of control across the state, especially rural areas like Navajo and Apache counties. The daily average of new cases in the past two weeks have risen 59% statewide — with a 138% increase in deaths and a 50% increase in hospitalizations.

Apache County has reported 127 cases per 100,000 and Navajo County 114 cases per 100,000 per day, based on a seven-day average. By contrast, the state average is just 87 cases per 100,000.

Nationally, cases have risen 30% and deaths 67% in the past two weeks as a daily average. That works out to 65 per 100,000 — about half the Apache County rate. The death tolls nationally has grown to about 2,000 people daily.

The pandemic has claimed 300,000 lives nationally, including 3,000 in Arizona.

The rapid spread of the virus and the rising death toll makes the priority setting decisions for the vaccine a matter of potential life and death for people waiting their turn.

It’s unclear who will come next on the priority list after healthcare workers and nursing homes.

Arizona will give second priority to front line workers, including teachers, law enforcement, fire, utilities, food and agriculture and other essential services.

Some states have stressed the need to vaccinate the people most at risk of death, including those over 65 and people with co-morbidities like diabetes, obesity, high blood pressure, compromised immune systems, lung problems and other conditions.

If those at higher risk of death get priority, it will likely benefit the Navajo and White Mountain Apache reservations, given the high incidence of high-risk conditions. Overall, the death rate among Native Americans from COVID-19 has been about double the rate in the overall population. The Navajo Nation is once again on a total lockdown, after cases spiraled out of control in recent weeks.

However, Arizona opted to prioritized “essential workers” with front-line contact with the public.

The Pfizer vaccine received federal approval over the weekend and doses were shipped nationwide early this week. However, the company can’t manufacture nearly enough to inoculate everyone.

A second, similar, two-dose vaccine made by Moderna could win approval this week. It doesn’t require such careful handling, so rural areas like Apache and Navajo counties will likely have to wait for the Moderna vaccine for their first doses, according to the state health department.

The Pfizer vaccine comes in special boxes packed with dry ice to keep the temperature at 80 degrees below zero. One can only open the 975-dose boxes twice before they have to quickly use the vaccine. Rural areas would have trouble using all the doses before they spoiled, said Layton.

The vaccine won’t tame the pandemic until perhaps 70% of the population gets the shot, conferring a form of “herd immunity.” That probably won’t happen until this summer, say disease experts — providing most people prove willing to get the shot. Once 70 to 90% of the population has either gotten a vaccine or recovered from an infection, the virus will likely die out in the protected population without enough fresh hosts to sustain its spread.

The Pfizer and Moderna vaccines are based on a breakthrough messenger RNA technology, which prompts the body’s muscle cells to produce a distinctive spike protein the virus uses to infiltrate cells. Three or four layers of the body’s immune system react to the protein, priming the immune system against later infection by the actual virus. Large-scale clinical trials suggest both the Moderna and Pfizer vaccines are 95% effective with no serious side effects. Some people in the clinical trials reported feeling feverish, with muscle aches and fatigue for a day or two.

Great Britain has already started the vaccination of risk groups and health workers with the Pfizer vaccine. Some people with a history of hyper immune sensitivity and allergies have reported an especially strong reaction to the shot. The vaccine has not been tested in children or pregnant women.

The challenging logistics of the Pfizer and Moderna vaccines have posed daunting logistical problems for the health care system, given the unprecedented speed of the vaccine development and the challenges of curtailing a global pandemic. The U.S. months ago turned down offers to pre-order more of the now approved vaccines and so is now guaranteed only enough doses to vaccinate about 50 million people in a population of 320 million.

Russia and China have already launched mass vaccination campaigns with their own shots that did not go through complete, Phase III trials for safety and efficiency.

The US was counting heavily on another, more traditional vaccine, which has struggled to complete clinical trials. The vaccine’s made by AstraZeneca in collaboration with researchers from Oxford University. The US invested $1 billion to guarantee delivery of 300 million doses of that two-dose vaccine, which accounted for about 60% of the doses the US has guaranteed. The AstraZeneca vaccine uses a harmless virus that causes cold-like symptoms in chimpanzees to forearm the immune system against COVID-19. This approach worked well with no safety problems in vaccinating against a close relative of COVID-19. Tests in animals and small groups of human volunteers showed the virus was effective and safe, but large-scale clinical trials have stumbled.

The drug maker delayed fully reporting on some complications that turned out to be unrelated to the vaccine. More importantly, the drug maker reported surprising results showing the vaccine worked best if people were initially given a half-dose and then a full dose three weeks later. The weak first dose resulted in 90% protection, while two full doses produced 60% protection — a finding that still baffles researchers. The most effective combination of the vaccine hasn’t been fully tested in those over 65, a critical risk group for COVID-19. In Arizona, those over 55 account for about 88% of deaths.

However, the AstraZeneca vaccine doesn’t require special handling and costs about one-tenth as much as the Moderna or Pfizer vaccines. This makes it potentially much easier to use in a global vaccination campaign.

Dozens of other vaccines are in the pipeline — including a one-dose vaccine made by Johnson and Johnson, which would also be much cheaper and easier to administer globally than the Moderna or Pfizer vaccines. However, the approval of two effective vaccines could complicate the clinical trials for all those other vaccines — since they can no longer be ethically compared to a saline placebo. Instead, trials may have to be altered to compare them to the existing, approved vaccines.

Peter Aleshire covers county government and other topics for the Independent. He is the former editor of the Payson Roundup. Reach him at paleshire@payson.com

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