US-Mexico Transborder Collaboration: COVID-19 Vaccines in Arms Across Borders

ACADEMIA Letters US-Mexico Transborder Collaboration: COVID-19 Vaccines in Arms Across Borders Cecilia Rosales, University of Arizona Mel and Enid Zuckerman College of Public Health Tina Fingesi, University of Arizona Mel and Enid Zuckerman College of Public Health Daniel Derksen, University of Arizona Mel and Enid Zuckerman College of Public Health ABSTRACT The COVID-19 pandemic revealed widening health disparities and disproportionate adverse health outcomes in terms of transmission, hospitalizations, morbidity, and mortality among Arizona’s rural, Latino, immigrant, and elderly populations. Unfortunately, these are the very populations that had much lower rates of being vaccinated in the early weeks of Arizona’s COVID-19 vaccination roll. To address these alarming health disparities, the leadership of the University of Arizona Health Sciences Center, through our Primary Prevention Mobile Health Unit (MHU)-established a bold new initiative tagged: Mobile Outreach Vaccination & Education for Underserved Populations (MOVE-UP) in Arizona to expedite vaccinations to vulnerable and hard-to-reach individuals within the state; thereby improving COVID-19 vaccination uptake and reducing disparities in cases and mortality rates. The MHUs vaccination program has been an opportunity to contribute meaningfully during an unprecedented global health crisis as we are experiencing since the onset of COVID-19 pandemic. Academia Letters, December 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Cecilia Rosales, crosales@arizona.edu Citation: Rosales, C., Fingesi, T., Derksen, D. (2021). US-Mexico Transborder Collaboration: COVID-19 Vaccines in Arms Across Borders. Academia Letters, Article 4484. https://doi.org/10.20935/AL4484. 1 INTRODUCTION The COVID-19 pandemic revealed widening health disparities and disproportionate adverse health outcomes in terms of transmission, hospitalizations, morbidity, and mortality among Arizona’s rural, African American, American Indian, Latino, disabled and elderly populations (Romano et al., 2021). Unfortunately, these are the very populations that have much lower rates of being vaccinated in the early weeks of Arizona’s COVID-19 vaccination rollout. Intractable health disparities relate to social determinants including socioeconomic status, educational attainment, low wages for essential workers, rural location, being elderly or disabled, having limited English-speaking skills, immigration status, unreliable transportation, difficulty obtaining childcare and other factors. Stigma, ageism, racism, and anti-immigrant policies further impede access to health services including COVID-19 testing and vaccination (Rosales et al., 2016). Arizona is a landlocked state situated in the southwestern United States, its 362-mile border with Mexico is integral to its history. Cochise, Pima, Santa Cruz, and Yuma are the border counties that shapes immigration’s impact in the state. The high prevalence of chronic diseases, in combination with quality of medical attention, have likely contributed to relatively high COVID-19 mortality among the non-elderly population in Mexico with 50.6% of all deaths occurring among population less than 65 years old, compared to 18.7% in the United States (Sánchez-Talanque et al., 2021). As of the 4th of January 2021, Arizona reported its highest number of COVID-19 cases in a day to about 12,435cases (ADHS 2021). The Unique Binational Collaboration The Arizona-Sonora border region has a long history of transborder collaboration and a successful record of public health and healthcare research, teaching, service coordination, and cooperation over many years in a very binational approach. The vaccination program was especially welcome by essential workers of the Mexican Maquiladora industry -a U.S. manufacturing company operating under a special tariff program established and managed by the United States and Mexico (Yagar, 2003). At the initial push to vaccinate the state population and across the country, vaccines were in short supply; but overtime and with the new federal administration committed to increasing vaccination rates to “community immunity” levels, the supply was overabundant. An unintended consequence of this oversupply and the growing hesitancy to receive the vaccine by specific groups within the U.S., we found vaccines reaching expiration. As a result, an advocacy campaign was launched by various binational organizations such as the Arizona-Mexico Commission and the US-Mexico Border Health Commission, actively educating Congressional Delegates, the Secretary of Health and HuAcademia Letters, December 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Cecilia Rosales, crosales@arizona.edu Citation: Rosales, C., Fingesi, T., Derksen, D. (2021). US-Mexico Transborder Collaboration: COVID-19 Vaccines in Arms Across Borders. Academia Letters, Article 4484. https://doi.org/10.20935/AL4484. 2 man Services, among others about the importance of avoiding the disposal of close-to-expiring vaccine and exploring creative ways to get these shots into willing arms (VDOH 2021). Mobile Health Unit and MOVE-UP Initiative The Primary Prevention Mobile Health Unit Services were initially funded by the Mexico Section of the US-Mexico Border Health Commission in 2016 (Rangel Gómez et al., 2019; Flynn et al., 2021). Arizona was funded for two Mobile Health Units (MHUs), however there is a total of eleven MHUs located in strategic, and predominantly Latino concentrated cities that include Tucson, Phoenix, Los Angeles, Las Vegas, Denver, Chicago, Dallas, Raleigh, New York, Orlando, and Miami. The Tucson and Phoenix based MHU include vaccination for COVID-19 and flu, blood glucose checks, blood pressure; HIV & Hepatitis C screenings, assistance with eligibility and enrollment for AHCCCS (Medicaid), KidsCare (CHIP), referrals for mammograms and other cancer screening, fluoride varnish for children, orientation and education on health insurance registration, and active follow up to ensure participants learn how to access care locally at Federally Qualified Community Health Centers(FQHC), rural or critical access hospitals (CAHs) and telehealth services. METHODOLOGY Overview To address these alarming health disparities, the leadership of the University of Arizona Health Sciences Center, through the MHU-housed within the UArizona Mel & Enid Zuckerman College of Public Health; used internal funding to establish a bold new initiative: Mobile Outreach Vaccination & Education for Underserved Populations (MOVE-UP) in Arizona (Hanna et al., 2018). The MOVE-UP uses existing MHUs in collaboration with health providers, health profession students and trainees, AzAHEC Regional Centers, County health departments and the Arizona Department of Health Services (ADHS) to expedite vaccinations to vulnerable and hard-to-reach individuals and populations within the state. Protocol In collaboration with Maricopa County, the MHU team first successfully implemented a pilot vaccine distribution program for seniors in a public housing complex, this pilot served to test the MHU’s registration and distribution process. Utilizing this approach, the MHU team calls and/or text participants in a target community prior to the delivery program and pre-register Academia Letters, December 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Cecilia Rosales, crosales@arizona.edu Citation: Rosales, C., Fingesi, T., Derksen, D. (2021). US-Mexico Transborder Collaboration: COVID-19 Vaccines in Arms Across Borders. Academia Letters, Article 4484. https://doi.org/10.20935/AL4484. 3 them over the phone, using the state Vaccine Management System (VMS). The team then travels to the community to give the vaccine shots on site; all data collected was HIPPA compliant and treated with confidentiality. Following this successful pilot, we began expanding the program to reach more of our underserved communities throughout the state, including the border areas at the Ports of Entry in collaboration with the Secretary of Health of Sonora, the Mexican Consulate, and the Santa Cruz County Health Department. The Secretary of Health of Sonora requested that we afford vaccine recipients proof of vaccination in Sonora; therefore, while they waited during the 15-30-minute observation period (time to observe any adverse reactions to vaccine administration), recipients also completed the VMS consent form from the Secretary of Health of Sonora. In addition, community health workers provided onsite education on COVID-19 transmission and communicated prevention strategies to protect family members living in the same household; this is an example of the binational history of the region. Target population We aligned MHU’s approach to the county and state priority distribution groups and timelines based on the CDC/ADHS guidance recommendations. Our priority group once the mandate was established to provide vaccinations, was the Spanish speaking Latino population, 75 and older residing in senior living facilities. farmworkers with large workforce, H2A visa workers, the meat packing industry, food service industry, cross border transport drivers, and other essential workers. We also proposed transfer of the close-to-expiring vaccine in time for Sonoran communities that border Arizona, to receive the vaccine. RESULT In coordination with Arizona County Departments of Public Health, the MOVE-UP initiative has successfully administered a total of 47,636 COVID-19 vaccine shots (Table 1) between February to December 1, 2021; in urban and rural Arizona counties. Academia Letters, December 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Cecilia Rosales, crosales@arizona.edu Citation: Rosales, C., Fingesi, T., Derksen, D. (2021). US-Mexico Transborder Collaboration: COVID-19 Vaccines in Arms Across Borders. Academia Letters, Article 4484. https://doi.org/10.20935/AL4484. 4 Table 1. A sub-total of 31,048 COVID-19 vaccine doses was administered in the five ports of entry in Arizona: Douglas, Lukeville, Naco, Nogales and San Luis (Figure 1); 15,566 vaccine doses administered in Maricopa -the most populated County in Arizona and 1,022 doses in the four US-Mexico border counties in Arizona: Santa Cruz (357 doses), Yuma (317 doses), Cochise (280 doses) and Pima (68 doses). Academia Letters, December 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Cecilia Rosales, crosales@arizona.edu Citation: Rosales, C., Fingesi, T., Derksen, D. (2021). US-Mexico Transborder Collaboration: COVID-19 Vaccines in Arms Across Borders. Academia Letters, Article 4484. https://doi.org/10.20935/AL4484. 5 Figure 1. Of the administered doses in the ongoing community intervention on COVID-19 vaccine; 51% (24,319) was Pfizer-BioNTech, 27% (13,058) was Janssen (Johnson & Johnson) and 22% (10,259) was Moderna. Of the Arizonan population who have received at least one dose of the vaccine as of December 13, 2021; 47.0% (2,149,695) are White/non-Hispanic; only 18.5% (844,502) are Latino, 4.3% (194,888) are American Indian/non-Hispanic, 3.8% (174,171) are Asian/non-Hispanic and 3.0% (137,789) are Black/non-Hispanic. This significant margin in vaccination among Whites and Persons of Color reveals some of the social determinants of health (SDOH) that impinged on health parity and equities among residents of the US-Mexico border counties. DISCUSSION The current COVID-19 crisis has elucidated the highly interdependent relationship between the United States and Mexico. The mobile health units deployed to help address immediate COVID-related disparities has delivered vaccinations to thousands of individuals in underserved areas, including farm workers, truck drivers, Spanish-speakers, and homeless populations -in collaboration with the University of Arizona MOVE-UP initiative, US Customs and Border Protection, Maquiladora Industry, Local County Health Department and Mexican Academia Letters, December 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Cecilia Rosales, crosales@arizona.edu Citation: Rosales, C., Fingesi, T., Derksen, D. (2021). US-Mexico Transborder Collaboration: COVID-19 Vaccines in Arms Across Borders. Academia Letters, Article 4484. https://doi.org/10.20935/AL4484. 6 Consulate Offices located along the Arizona-Sonora border. The MHU vaccination program has been exciting and educational as well as an opportunity to contribute in meaningful ways during an unprecedented global health crisis as we are experiencing. Students have had experiences vaccinating, scribing, registering, and observing during our vaccine events providing unique opportunities to learn outside of the confines of the classroom or the traditional hospital or clinic setting. Despite the MHU’s continuous vaccination effort across the state, there still exist a steep gap in the ratio of vaccinated to unvaccinated population in the state, with a more apparent disparity among Persons of Color. Our MOVE-UP initiative continues to make vaccines accessible to the hard-to-reach community; and we have found an increasing demand for vaccination services from businesses and organizations with small and large numbers of employees, most of which are US manufacturing companies located along the Arizona-Sonora border. To better address public health in the bilateral relationship, we propose several areas for present and future cooperation: the MHU vaccination project is one of the impactful ways in which the United States and Mexico can collaborate to improve delivery of healthcare (Wood and Rudman 2020). It is therefore pertinent for agencies and organizations to support such an important effort that contributes to increasing COVID-19 vaccination rates, not only in the Arizona-Sonora region, but across all states. Academia Letters, December 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Cecilia Rosales, crosales@arizona.edu Citation: Rosales, C., Fingesi, T., Derksen, D. (2021). US-Mexico Transborder Collaboration: COVID-19 Vaccines in Arms Across Borders. Academia Letters, Article 4484. https://doi.org/10.20935/AL4484. 7 References Arizona Department of Health Services (2021). https://www.azdhs.gov/covid19/data/index. php Flynn, M. A., Lainz, A. R., Lara, J., Rosales, C., Feldstein, F., Dominguez, D., Wolkin, A., et al. (2021). An Innovative United States–Mexico Community Outreach Initiative for Hispanic and Latino People in the United States: A Collaborative Public Health Network. Public Health Reports, 136(3), 287-294. Hanna, J. J, Gonzalez-Fagoaga, E., Gomez, G. R., & Rosales, C. (2018). Health Awareness for Underserved Hispanic/Latino Populations through a Primary Prevention Mobile Health Unit. Annual Meeting and Expo. Minimizing Vaccine Waste. Vermont Department of Health (2021). https://www.healthvermont. gov/sites/default/files/documents/pdf/COVID19-Vaccine-Minimize-Waste-Policy.pdf Rangel Gómez, M. G., López Jaramillo, A. M., Svarch, A., Tonda, J., Lara, J., Anderson, E. J., & Rosales, C. (2019). Together for health: an initiative to access health services for the Hispanic/Mexican population living in the United States. Frontiers in public health, 7, 273. Romano, S. D., Blackstock, A. J., Taylor, E. V., Felix, S.E., Adjei, S., Singleton, C., Fuld, J., Bruce, B. B., & Boehmer, T. K. (2021). Trends in Racial and Ethnic Disparities in COVID19 Hospitalizations, by Region- United States, March-December 2020. CDC Morbidity and Mortality Weekly Report. 70(15), 560–565. Rosales, C. B., Carvajal, S. C., Zapien, J. E. G. (2016) Editorial: Emergent Public Health Issues in the US-Mexico Border Region. Frontiers in Public Health. 4:93. https://doi:10. 3389/978-2-88945-047-3 Sánchez-Talanque, M., Gonzalez-Pier, E., Abascal-Miguel, L., Fieldhouse, J., Rio, C., & Gallalee, S. (2021). Mexico’s Response to COVID-19: A Case Study. UCSF Institute for Global Health Science. Wood, D. & Rudman, A. I. (2020). Pandemics and Beyond: The Potential for U.S.-Mexico Cooperation in Public Health. Wilson Center Mexico Institute. Academia Letters, December 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Cecilia Rosales, crosales@arizona.edu Citation: Rosales, C., Fingesi, T., Derksen, D. (2021). US-Mexico Transborder Collaboration: COVID-19 Vaccines in Arms Across Borders. Academia Letters, Article 4484. https://doi.org/10.20935/AL4484. 8 Yagar, L. (2003). Mexico’s Maquiladora Decline Affects U.S.-Mexico Border Communities and Trade; Recovery Depends in Part on Mexico’s Actions: A Report to Congregational Requesters. Academia Letters, December 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Cecilia Rosales, crosales@arizona.edu Citation: Rosales, C., Fingesi, T., Derksen, D. (2021). US-Mexico Transborder Collaboration: COVID-19 Vaccines in Arms Across Borders. Academia Letters, Article 4484. https://doi.org/10.20935/AL4484. 9