Vaccine plan lacks critical details
COVID-19 drug remains in short supply for distribution
The plan to implement Maryland’s new policy enabling adults 65 and older to start getting inoculated for COVID-19 lacks critical details that officials and experts say could hamper the ability to ensure all those who want the vaccine can get it anytime soon.
The updated guidelines, announced Thursday by Maryland Gov. Larry Hogan, allow adults 75 and older, as well as teachers and some others, to start getting vaccinations Monday, with people 65 and older becoming eligible the following week.
But the number of available vaccine doses, vaccinators and appointments remains scarce in this state and across the country as the coronavirus continues to ravage the nation and demand for vaccinations soars. More people died of the disease caused by the virus Tuesday than on any other day since U.S. officials began tracking fatalities in March.
After Hogan publicized the new eligibility outline, phone lines clogged at local health departments and hospitals that have been tasked with vaccinating some 500,000 people in the state’s initial rollout phase. Health care workers, first responders and nursing home residents and their caretakers have received most of the 195,795 doses administered so far, and just under 16,000 Marylanders have received the required second doses, the U.S. Centers for Disease Control and Prevention reported Friday.
Baltimore Health Commissioner Letitia Dzirasa said the city has been inundated with phone calls since Hogan’s announcement to expand vaccinations to additional residents. Dzirasa pleaded with city residents to be patient, noting that all the city’s appointments for vaccinations through the end of January are already booked.
“We’re working to add capacity for more appointment slots through external partners as rapidly as possible,” she said, adding that health officials were working to confirm the eligibility of those who have managed to schedule appointments. She said she remains confident that those who have received the first of two required doses will get their second on schedule.
Mike Ricci, a spokesman for Hogan, said the governor conferred with the CDC director, the incoming White House COVID19 coordinator and Maryland’s task force before expanding eligibility. He said the Hogan administration received a request from county leaders for more flexibility, and the ability to move through the phases quicker.
“This is going to take a great deal of patience
and more vaccines” Ricci acknowledged in an email. “Supply is not nearly where it needs to be, so you’re going to see clinics fill up quickly and people having a hard time getting appointments at first, wait lists, and the like.”
He continued: “It’s going to take time for everyone in every group to get vaccinated, but both outgoing and incoming federal health officials agree we need to begin to start working our way into the general population, regardless of where the supply level is.”
Vaccine allocation has moved slowly across the country as states draft and implement individual plans for moving shots into arms and manufacturers ramp up production. So far, about 40% of the doses distributed to states have been administered, CDC data show.
Money, manpower and crunched planning timelines have contributed to delays as overburdened hospital systems and health departments not only work to inoculate themselves and others in Phase 1A but also treat ill COVID-19 patients. A shortage of health care workers, particularly nurses, threatens to slow down progress even further.
The state’s vaccination expansion falls in line with that of other states as well as federal guidance from President-elect Joe Biden’s incoming administration, which has advocated for states to release almost every available vaccine dose as soon as it arrives rather than storing some for the second shots. The Biden administration wants to administer 100 million vaccinations in the president-elect’s first 100 days.
But some public health experts worry that could create a backlog of people who received just the first dose of vaccine and threaten the effectiveness of the protection it offers.
“You have to keep the system in line with reality,” said Ruth R. Faden, founder and former director of the Johns Hopkins Berman Institute of Bioethics. “You don’t want to introduce chaos and have the program collapse under its own weight.”
That means having enough vaccine to go around to groups deemed worthy, but that might be tough since there are no national stockpiles to boost supplies in the states.
Opening up vaccination appointments to more people creates enormous scheduling and logistics challenges for health officials, said Dr. William Moss, executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health.
More vaccinators will need to be brought on, Moss said during a virtual event hosted by the institution on Friday, and states will have to ensure that they have enough supplies prior to vetting potential candidates.
“We have to make sure we have the doses to match that demand,” he said. “If we start messing with that, we’re moving away from the science.”
Still, Moss said, the public health crisis lends itself to inoculating as many people
as soon as possible, and loosening eligibility requirements by age groups could be easier for officials to vet than having to verify a comorbidity or underlying health condition.
It’s also possible more vaccine candidates will receive U.S. Food and Drug Administration authorization in the coming months or weeks, which could create additional streams of inventory.
But with a new, more contagious variant now spreading around the United States and poised to become the dominant strain by March, vaccinating the most vulnerable will be necessary to curb the strain on the health care system.
“We are in a terrible pandemic, and it does seem tragic to hold on to doses when we have 3,000 to 4,000 people die a day,” Moss said.
Maryland officials also must create equitable pathways for older adults, people with disabilities and low-income vaccine candidates to schedule appointments, state Senate President Bill Ferguson said.
Ferguson, a Democrat from Baltimore, said he and fellow senators will be scrutinizing the state’s performance with the vaccine rollout as they weigh whether to confirm the state’s acting health secretary, Dennis Schrader.
“What I’m very concerned about in this situation is that it was not accompanied with a clear communications plan to proactively reach out to those who aren’t going to jump on their computer, log in with their email and sign up for the vaccine,” Ferguson said.
A newly erected state website meant to help people schedule appointments only lists phone numbers and web addresses for county health departments and other vaccination clinics. Johns Hopkins Medicine, one of the vaccinator options listed, instructs people through its website to refrain from calling to ask about making appointments.
“Our goal at Johns Hopkins Medicine is to make the process of getting vaccinated for COVID-19 as seamless as possible given the quickly changing situation and limited supply,” a spokesman said. “At the same time, we need to keep our phone lines open for patients in need of other care services.”
Some older adults already have expressed frustration about the guidelines expanding without the infrastructure in place to serve them. Marie Kaplowitz, 75, went to the state and local health department websites Friday and found little information on how to get vaccinated.
“I was very disappointed. I was very put off,” she said.
The Howard County resident should be eligible to get the vaccine beginning on Monday. She said she found the state website confusing, and after filling out a survey on the Howard County health department website, she got a message back saying that in a few weeks she would be sent information on how to make an appointment.
“I am not looking to get this before March, the way things are going,” said Kaplowitz,
whose husband, who will turn 75 in April, has underlying health conditions and needs the vaccine as well.
After Hogan’s announcement, Baltimore County health officials worked feverishly to set up a separate registration form by 5 p.m. Friday for residents to fill out their information and receive notifications when they become eligible and appointments open.
More than 4,000 people logged on to the new registry in the first 90 minutes it was live, Dr. Gregory Wm. Branch, Baltimore County’s health officer, said late Friday. He said the county will take people in the Phase 1B category in the order in which they sign up, and will move to the next category as the amount of vaccine allows.
Tammy Bresnahan, AARP Maryland’s associate state director of advocacy, said she’d been getting calls and was happy that older, most vulnerable people have been included in the expanded categories but expressed some concerned about how it would work.
“I’ve been getting calls and all people want to know is where they can go to get it and how they sign up,” she said.
She was glad Hogan opened a website with information. But she said of the health departments, “I hope they are ready to get calls. I hope this isn’t premature.”