Arizona plans to start COVID-19 vaccinations next week. Here is what you need to know

Hope is on the horizon: A vaccine for COVID-19 is expected to soon start rolling out, focusing first on those at highest risk of contracting the disease or experiencing serious complications from it.

The U.S. Food and Drug Administration authorized emergency use of the Pfizer vaccine Friday night. 

Doses are expected to arrive in Arizona within days, with inoculations for some health care workers beginning next week.

The next few months will be challenging. Already, daily death counts nationwide break new records. It will take months until the vaccine has been administered to the general public broadly enough to return to any semblance of pre-pandemic life. 

Dr. Cara Christ, director of the Arizona Department of Health Services, feels a sense of hope, seeing the light is at the end of the tunnel.

Without the hope of a vaccine coming so soon, the pandemic, at this stage, would feel "almost overbearing," she told The Arizona Republic Thursday.

But the vaccine rollout will have its own hurdles.

"This is going to be a significant logistical challenge. There's a lot of moving parts. We're relying on a lot of different supply chains coming together," she said.

You have questions about how the vaccine works, how it will be rolled out and how your specific situation applies.

We have some answers, though not all questions have firm responses yet. 

How does the vaccine work? Is it effective?

Both the Pfizer and Moderna vaccines, which are awaiting emergency-use authorization from the FDA, are messenger RNA, or mRNA, vaccines. 

They don't contain the virus itself, like some vaccines for other diseases do. Instead, they contain materials that give our cells instructions on how to fight off the virus. 

The Centers for Disease Control and Prevention describes the vaccine's process like this: "mRNA can most easily be described as instructions for the cell on how to make a piece of the 'spike protein' that is unique to SARS-CoV-2. Since only part of the protein is made, it does not do any harm to the person vaccinated but it is antigenic."

They both require two doses to be fully vaccinated, with the second shot delivered 21 to 28 days after the first shot. 

They do not alter your DNA or genetic material, despite conspiracy theories you may have read on social media. The messenger RNA doesn't enter the cell's nucleus, where DNA is stored. And the cell also disposes of the mRNA, using enzymes, after the instructions are utilized.

Pfizer's vaccine showed 95% effectiveness at preventing COVID-19 illness. Moderna's effectiveness rate was 94%. For context, flu vaccines, created and administered annually, on average are about 40% effective at preventing illness.

When will the first doses of the vaccine start rolling out?

The state health department expects that the first shipment of about 58,000 Pfizer vaccines will arrive in Arizona next week. Maricopa County will receive about 47,000 doses and Pima County about 11,000 doses to begin vaccinating the first priority group of at-risk health care workers.

Christ said some ancillary supplies should arrive Thursday or Friday, and the state expects the Pfizer vaccine itself to arrive on Dec. 15 or 16, depending on FDA approvals.

The week after, vaccine doses will be sent to all 15 counties, at least four tribes and skilled nursing facilities through a partnership with the U.S. Centers for Disease Control and Prevention, according to the governor’s office. All of Arizona’s skilled nursing facilities have opted into the CDC program to vaccinate all residents and staff.

Arizona is expected to receive 384,350 COVID-19 vaccine doses by the end of December, which the state estimates should be enough to cover the first doses for the health care workers and long-term care residents who want to be vaccinated.

Only after those groups are vaccinated and more doses arrive will the state turn to the next priority groups: essential workers, adults over 65 and adults with high-risk medical conditions, followed lastly by the general public.

How will the vaccines be safely transported and stored to the ultra-cold temperatures required?

Arizona expects to get vaccines from both Pfizer and Moderna in December. The state Health Department will order doses from the federal government to be shipped directly to those providing the vaccinations in Arizona.

Only the Pfizer vaccines require ultra-cold storage. The Pfizer vaccines will be shipped in batches of at least about 1,000 doses to vaccine providers in thermal boxes with rechargeable dry ice. Doses will be stored in ultra-cold freezers until they’re administered but can be stored in dry ice boxes for 10 days, the state's vaccine distribution presentation says.

The Moderna vaccines can be shipped in smaller orders of 100 doses or more and are stable for 30 days refrigerated and can be stored frozen.

Pfizer initial doses are mostly going to Maricopa and Pima counties, where mass vaccination is more feasible in the early phase, while Moderna vaccines will at first go more to rural areas because they come in smaller shipments and do not require ultra-cold storage, according to the state’s plans.

When will the general public get vaccinated?

Vaccinations should be open to the general population by March or April, Christ said. Hundreds of millions of doses are expected to be available by March, she said.

Prioritization is important when there are limited doses available because the vaccine has to be allocated where it will have the biggest benefit, but production should ramp up in weeks to months, Christ said.

How can I sign up? 

It’s still too early for the general public to sign up to be vaccinated.

“The general public will still be quite a while out,” Christ said.

The general public comes after priority groups that include health care workers, long-term care facility members and essential workers. 

For the first priority group of health care workers, the registration process may differ by county. Maricopa County, for example, will be sending health care workers a pre-screening form and then will email qualified workers so they can register for the vaccine. 

The state has a vaccine management system to help preregister and prioritize health care workers and remind people when it's time for their second dose.

Christ said she is not sure yet when she personally will be vaccinated, but said public health does fall under the essential worker category and she has some health care worker roles as well.

Where will I get the vaccine?

In the early stages, vaccine doses will go to approved health care providers. Initially, these providers will administer the vaccines at sites for specific groups. In Maricopa County, for example, five sites will be available to vaccinate people in the initial phase, largely health care workers.

Once the first priority groups have received their vaccinations, the process for secondary priority groups and the general public in spring or summer is expected to largely look like how you get a typical vaccine.

You would go to a health care provider or pharmacy location, get your shot and go about your day.

How much will it cost?

It will be free to get the COVID-19 vaccine, with or without health insurance.

Arizona Gov. Doug Ducey issued an executive order that ensures Arizonans can receive the COVID-19 vaccine free of charge for as long as the state's public health emergency declaration is in effect.

Ducey has given no indication that he intends to end the state's public health emergency in the near future.

Will vaccination be mandatory?

Vaccination will not be made mandatory by the state.

Maricopa County public health officials will be asking all residents to get vaccinated but will not mandate it.

Employers may require some of their employees to be vaccinated before returning to work.

I already tested positive for COVID-19. Should I get the vaccine?

It's not yet known for sure how long natural immunity lasts for those who have contracted COVID-19. Cases include people who had symptoms and those who did not, and their immune responses could create different levels of antibodies, the proteins our immune system creates when it fights off an infection. 

Some early studies have suggested natural immunity doesn't last very long, but the CDC says more study is needed before it can make an official recommendation on whether people who have recovered should get vaccinated. 

Arizona's Health Department said there's nothing that would stand in the way of recovered individuals' ability to get the vaccine.

"A previous COVID-19 positive diagnosis does not prevent an individual from receiving vaccine or hinder the vaccine's ability to work effectively," said Holly Poynter, a spokesperson for the state health department.

Other experts have said the same, according to the Miami Herald.

After I get vaccinated, when does it start to be effective?

There may be a brief period of time after you finish your COVID-19 vaccine course before you should consider it fully effective.

The Pfizer vaccine, which is now in use for initial phases of vaccination, requires two shots, spaced three weeks apart. One week after the second dose, the vaccine was 95% effective, the company found in its trials.

Depending on which vaccine you end up getting, the specifics of the effectiveness percentage and timeline may differ.

Health officials recommend continuing to wear face coverings and physically distance until the broader community is vaccinated.

What percentage of Arizonans must get the vaccine for us to reach herd immunity?

This question isn’t easy to answer, Christ said.

Herd immunity refers to the level of a population that carries immunity, either through vaccination or infection, from a given illness, meaning the illness is hindered from spreading to new hosts. Once an area reaches herd immunity, even those who have not been vaccinated or infected are more protected from illness.

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With some vaccines, herd immunity requires a high vaccination rate. For something like measles, which is highly contagious, herd immunity is about 95% vaccinated, she said. For the seasonal flu, it’s much lower, sometimes in the range of 40% vaccinated, she said.

The COVID-19 rate is probably somewhere in between those two, Christ said.

Are there potential side effects to the vaccine?

The vaccines cannot actually give you COVID-19.

As with other vaccines, you could experience some side effects, however.

Side effects result from the body mounting an immune response, which happens when we fight off infections as well.

Potential side effects observed in the clinical trials included inflammation at the injection site, fever, muscle aches and headaches. 

If I have allergies, should I get the vaccine?

Two health care workers experienced anaphylaxis, a severe allergic reaction, after getting the Pfizer vaccine in the United Kingdom this week. Both recovered. Both had history of these kind of allergic responses.

But the instances led British regulators to warn those who have had a “history of anaphylaxis to a vaccine, medicine or food” to not take the Pfizer vaccine.

If you have had a history of this kind of response to food, medicine or vaccines, check with a health care provider.

Minor allergies, like seasonal allergies, have not been mentioned as a concern with the Pfizer vaccine.

The British regulators have said it is only the extreme response of anaphylaxis that is currently a concern, which they said was “very rare” side effect that can result from any vaccine.

When can we start doing activities safely again? 

By the summer, or at the latest fall, enough Arizonans likely will be vaccinated for a resumption of some activities. 

“With hundreds of millions of doses available by spring, hopefully by the summer the majority of the people who want to get vaccinated should be able to access vaccines,” Christ said.

If I get vaccinated, am I then able to move about in the world like I did before the pandemic? 

For people getting vaccinated in the earliest phases, like health care workers, Christ said she would still recommend they wear appropriate personal protective equipment when seeing patients because the vaccine is not 100% effective.

The general public should continue to wear masks when they’re out because it will take time for enough of the population to be immunized.

“We just want to make sure that we’re keeping everybody healthy until we can see what the impact of the vaccine is on the community,” Christ said.

Will I know which vaccine is being administered where? Can I choose which vaccine I get?

At this stage, Arizona expects to receive doses of the Pfizer and Moderna vaccines in December, pending FDA approval. No other vaccines have submitted applications to the FDA yet, but they may in the future.

When the time comes, you can call providers and ask which one they are administering. At least initially, it’s likely that people will not have a choice.

For the Pfizer and Moderna vaccines, they work similarly to mRNA vaccines and both have two doses. Other potential vaccines that eventually could be approved may have just one dose.

Who counts as having high-risk medical conditions?

Adults with high-risk medical conditions, plus adults older than 65, will be able to get the vaccine after health care personnel, long-term care facility residents and essential workers, according to the state’s plan.

Qualifying underlying medical conditions include obesity, chronic obstructive pulmonary disease, heart disease, diabetes and chronic kidney disease, per state plans.

What’s the process of ‘proving’ what phase or group I am in?

County health departments play a key role in vaccine distribution, communicating with groups in early phases to tell them when and how they can access a vaccine, Christ said.

Counties may all operate differently in this regard. Some may work directly with health systems to find eligible employees in the first phase. Others could screen candidates directly.

Initially, specific facilities — health care systems, congregate settings, nursing homes, etc. — will be targeted as priorities.

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Once the state moves into the phases for people with underlying conditions, Christ said she expects the state will have many more doses and much wider availability. It’s possible people could self-report these conditions and access a vaccine at the pharmacy, she said.

“They might request proof of an illness or something, but by that time I would imagine that we're asking people either to just self-report that you're above 65 or that you have a high-risk medical condition,” she said.

I’m an essential worker under the executive order. Does that mean I’m an essential worker for vaccine distribution?

This is not yet clear and may depend on your county, Christ said. A county may determine whether an essential worker under the executive order is a priority for the vaccine, she said.

“They may determine in their community which ones they're going to start vaccinating, either because of the ease of access of employees or because of the critical nature of the job that they do,” Christ said.

State plans list "prioritized essential workers" followed by "essential workers" as priority groups for the vaccine. They would come next in line after health care workers and long-term care facility residents.

Prioritized essential workers include teachers, school staff and child care providers, plus law enforcement, corrections employees and other emergency response staff. Other essential workers include power and utility workers, food and agriculture workers, transportation-related employees, critical government workers and others.

People in support services at places like hospitals or schools also may be considered essential.

Can snowbirds (part-time residents/visitors) get vaccinated in Arizona?

State officials say snowbirds who only live here part of the year will be able to get vaccinated for free in Arizona and can get their second dose with the same vaccine in a different state, if needed. 

What about undocumented individuals?

They will be able to get vaccinated in Arizona for free. 

“Vaccine is one of those things that we make available no matter if you’re a winter visitor, if you’re here visiting from another country,” Christ said. “Because of the impact that the diseases that you vaccinate against have on the community, we want to make sure that we’re protecting everybody.”

Does teachers mean just classroom teachers or all school staff? What about university employees?

"Teachers" as a priority group includes school staff, bus drivers, cafeteria workers, front office, support staff and other school employees, as they all come into contact with kids and provide critical services for schools, Christ said. 

The state is focused on K-12-level vaccinations. Counties are reaching out individually to universities to discuss their prioritizations within the county, Christ said.

How will the state work to encourage vaccines and counter hesitancy? 

Public health has been dealing with vaccine hesitancy over many years, Christ said.

The department held community listening sessions with health care workers and the general public to identify vaccine fears, barriers, beliefs and who communities would trust and listen to on the topic.

The state Health Department is working on a communications campaign based on that data. 

Reach reporter Rachel Leingang by email at rachel.leingang@gannett.com or by phone at 602-444-8157, or find her on Twitter and Facebook.

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