Lawmakers peppered health officials with questions about the future of Nevada's vaccine outreach after the state terminated millions of dollars worth of grant agreements with the only statewide nonprofit working on increasing immunizations.

The questions came during an interim legislative meeting on Monday that marked the first public discussion of the state’s decision to terminate its relationship with Immunize Nevada following reports of “possible fraudulent activities,” an inability to comply with federal grant regulations and inadequate financial management, including more than six figures worth of unpaid payments to a vendor and struggles to pay staff members. The problems and termination of at least $4 million in state grants were first reported by The Nevada Independent last month.

Julia Peek, the deputy administrator of the community health services section of the Division of Public and Behavioral Health (DPBH), told state lawmakers Monday that officials had prepared immunization outreach contingency plans over the last year as they provided technical assistance to the troubled nonprofit in case the funding was terminated. She added that the state is working with other community partners to establish a coalition to fill the void left by Immunize Nevada.

“Between [the news becoming public] and now, easily 10, if not more, partners have reached out again, saying, ‘How do I fill the gap?’” Peek said during a meeting of the Legislature’s Joint Interim Standing Committee on Health and Human Services. “So, I think that will naturally occur through grassroots efforts.”

Nevada ranks 44th lowest in the nation for vaccination. Vaccine rates among adults in Nevada are significantly lower than the national average. Child immunization rates have also declined since the rollout of the COVID-19 vaccines, which Nevada health officials warned stems, in part, from a lack of “vaccine confidence.”

Three members of the committee — Assemblyman Duy Nguyen (D-Las Vegas), Assemblywoman Tracy Brown-May (D-Las Vegas) and state Sen. Fabian Doñate (D-Las Vegas) — raised questions during the meeting about how the terminated relationship could hinder state strategies surrounding vaccinations, especially in rural communities. They also asked about what the state could have done to help address the organization’s fiduciary issues earlier and any safeguards the state is erecting to prevent future financial issues among grant recipients.

“The key is to get folks to be more accountable in terms of operating and running projects like this in the future,” Nguyen said. “I’d really like to see some kind of regular updates from these organizations … because I didn’t even know that DPBH [had a partnership with Immunize Nevada].”

Immunize Nevada, a nonprofit, does not directly provide immunizations. Instead, it served as a statewide coordinator between various health entities to share vaccine information and organize and promote vaccination clinics for underserved communities. 

Largely grant-funded, the organization had partnered with the state for more than a decade to coordinate vaccine outreach with local health partners and served as the state’s main vaccine marketing arm, including coordinating the “3 million reasons” media campaign to support COVID-19 vaccination across Nevada.

Though Immunize Nevada Executive Director Sherilyn Duckworth was not present at the Monday meeting, she has maintained that the organization — which brought in $1 million or $2 million a year pre-pandemic but $11 million at its peak in 2021 — was not equipped to handle the amount of grant money the state had allocated to it during the COVID pandemic. She previously told The Nevada Independent that the grant money intended for subcontractors went to Immunize Nevada’s payroll and operating expenses. 

At that time, she also said that the organization’s financial troubles started before she was hired as Immunize Nevada’s executive director in January 2022, though past audits of the organization did not identify any significant financial management issues prior to 2022.

Duckworth initially said in a text message she wasn’t informed of the Monday meeting, adding it seemed like the state “wants to see Immunize Nevada fail.” Asked about an invitation she received on March 12 to speak about Immunize Nevada, Duckworth said she did not understand that The Nevada Independent was referring to that meeting, and believes the state has been communicating poorly.

Duckworth also said that after The Nevada Independent’s reporting, more than $200,000 in external funding had been pulled from the nonprofit and that the organization’s bank account is on hold. She added that because of the “one-sided” article, there had been a “domino effect” that led to her receiving hate mail and several partners breaking ties with the organization. The loss of state funding has left her hands tied, she wrote.

State officials did not offer updates on the more than $292,000 in federal dollars that the organization received from the state but had not paid to an outside vendor for services rendered. They said that other entities were owed money by Immunize Nevada, but did not offer further details. 

Asked by Doñate about Nevada Independent reporting indicating that staff members of the nonprofit had not been paid, Peek acknowledged that she had received similar emails from former staff members about nonpayment “for a period of time,” which she forwarded to the state labor commission. She is also encouraging the individuals who reached out to apply for positions at the state.

As of April 4, a spokesperson for the state’s Department of Health and Human Services said four former Immunize Nevada staff members had contacted the Division of Public and Behavioral Health about lack of payment.

Duckworth confirmed that employees, including herself, have “not been paid in months.”

“Immunize Nevada currently owes me tens of thousands [of] dollars,” Duckworth texted. 

What’s next for vaccine outreach?

The decrease in child immunization rates and increase in vaccine hesitancy following the COVID-19 pandemic is occurring as the U.S. has experienced a rise in vaccine-preventable diseases such as measles despite the wide availability of vaccines.

Though Immunize Nevada was focused on vaccine outreach and messaging, state officials say other policies could improve the rate, including making the human papillomavirus (HPV) vaccine a school requirement, removing religious exemptions and establishing programs that purchase vaccines on behalf of patients.

Kristy Zigenis, the Nevada State Immunization Program manager, said religious vaccine exemption rates in Nevada have continually risen since the 2020-2021 school year. The Centers for Disease Control and Prevention reports that the national vaccine exemption rate is about 3 percent, and Nevada has a 5.6 percent exemption rate, which harms state immunization efforts as vaccines are the best protection against severe diseases and hospitalization.

Immunize Nevada had been conducting outreach in rural communities, whose health districts lack the resources of more urban ones, such as Clark and Washoe counties. Peek said that with the partners who have stepped forward, the state will “be making sure that we fill that gap in promotion and convening [of vaccine events].”

Zigenis added that the short-term plans for meeting vaccination needs include contracting with a mobile vaccine vendor who can offer direct services in rural and urban areas and paying another agency to do widespread messaging specific to back-to-school and COVID-19 vaccine recommendations.

Immunize Nevada had also co-led the Nevada Vaccine Health Equity Collaborative with UNLV’s Nevada Minority Health and Equity Coalition before the grant termination. The collaborative is aimed at “promot[ing] the equitable distribution of the COVID-19 vaccine in Nevada.”

"UNLV remains committed to helping the state distribute vaccines and any related assistance throughout Nevada, especially to those in need,” UNLV spokesperson Francis McCabe wrote in an emailed statement to The Nevada Independent. 

Immunize Nevada had conducted targeted vaccine outreach in diverse communities across the state in various languages, going so far as to translate its website into Spanish, English, Simplified Chinese and Filipino. Nguyen asked state officials to continue to prioritize language access in its future vaccine outreach efforts.

Peek said the state wants to provide more technical assistance to nonprofit partners in the future and communicate with team members beyond executive directors.

“Are there things we could have done differently with this nonprofit? In hindsight, I personally would have liked to engage the board earlier,” Peek said. “There’s a lot more education, I think, that can be done.”