Disparities led to expanded rollout in state
Official: Broader guidelines addressed racial imbalance
Maryland officials quickly expanded the COVID-19 vaccine eligibility guidelines to include adults 65 and older in late January to compensate for preexisting racial disparities in life expectancy among seniors, the state’s acting health secretary said Monday.
“One of the things we learned is that 75 and older tends to be more dominated by Caucasians. And in order to get equity, we moved into 65-plus,” acting Secretary Dennis R. Schrader told state senators during a virtual Vaccine Oversight Workgroup committee meeting.
“Although we are focused definitely on 75-plus, we moved into 65-plus, and from an equity perspective, I think it’s an important thing — although it did add more people and it made it harder for us,” he continued. “But we felt it was worth it because of that.”
Many have criticized the state’s decision to add more people into the vaccine eligibility pool while supplies nationwide remained limited, saying it forced vaccine providers to make tough ethical decisions about who to prioritize for immunizations.
State officials expanded vaccine eligibility Jan. 18 to include adults 75 and older, and, by Jan. 25, a week later, they made people 65 and older — as well as some essential workers — eligible.
Schrader’s comments come as Maryland leaders and the state Department of Health continue to face questions about their rollout of the vaccine. Toward the end of last month, state data showed that white Marylanders have received about four times as many doses of coronavirus vaccine as Black residents. Lawmakers also are weighing whether to confirm Republican Gov. Larry Hogan’s nomination of Schrader for secretary of health, with Maryland Senate President Bill Ferguson saying Friday that the vaccine campaign needs to substantially improve.
“We need to see a radically better program that [makes it] clear and obvious when and where people get their vaccines,” Ferguson, a Democrat, said.
Elected officials, state lawmakers, county executives and health officers across Maryland have expressed frustration with the vaccination campaign, with some calling last month for a “course correction.” Harford County Executive Barry Glassman, a Republican, joined the calls Monday, issuing a statement that urged the state to distribute vaccines based on population, to create a one-stop registration system and to provide greater support for local health departments to reach vulnerable populations.
Schrader and Hogan have defended the process, citing a need for more vaccine from the federal government.
Still, some say the expansion simply came too soon.
“While Gov. Hogan gets credit for doing a lot of things well during the outbreak, vaccinations have not been done well,” said Dr. Georges Benjamin, executive director of the American Public Health Association and a former health secretary in Maryland. “He expanded capacity to 1C too soon before there was enough vaccine supply.”
Benjamin said supply is increasing, but not fast enough. Responding by expanding who qualifies, and giving counties a share of doses based on their size, won’t effectively or equitably distribute vaccine. Maryland needs to be more strategic, he said.
“Just simply making decisions based on population size is a problem,” he said. “Doses in mass vaccination sites in Prince George’s aren’t even going to people in the county. And Baltimore City hospitals are vaccinating a lot of people who don’t live in the city.
“I acknowledge the hesitancy issue, but it’s really an issue of access,” he said.
State officials have taken some steps to improve the inequities.
The mass vaccination center at the Baltimore Convention Center will prioritize individuals for appointments from six city ZIP codes hit particularly hard by the coronavirus pandemic; a new state-run program will set up mobile vaccination clinics at community hubs across the state; and more appointments at the mass immunization site at Six Flags America in Prince George’s County will go to residents of that jurisdiction, which is predominantly Black and has been lagging behind other counties in vaccination rates.
Meanwhile, President Joe Biden’s Democratic administration will invest $250 million to help localities reach at-risk and hard-to-reach populations, including rural communities, racial and ethnic minorities, and other vulnerable populations, the U.S. Department of Health and Human Services announced Monday. The funding will go toward “health literacy grants” for community-based organizations, according to the federal agency.
During Monday’s meeting, Schrader said the vaccination disparities were improving and he expected improvement to pick up momentum, leveling out to better reflect the population makeup.
But some state senators — citing a new Goucher College poll that showed minimal differences between Black and white respondents in their attitudes toward the vaccines — said the rollout still lacks clear, foundational answers.
“Is it a single person, a committee, who is deciding distribution?” asked state Sen. Mary Washington, a Democrat who represents Baltimore. “When we’ve asked this in the past, it’s been sort of vague ... the more we know about the critical supply chain, the better.”
Sen. Clarence Lam, a physician who represents Baltimore and Howard counties, noted that eligibility guidelines differ from county to county, creating confusion for constituents. He also said the health department attempting to reach some residents through such mechanisms as sound trucks do little to remedy the true barriers to access.
“Both you and the governor have cited ... vaccine hesitancy,” Lam, a Democrat, told Schrader. “If it’s vaccine hesitancy, some of the efforts you’ve undertaken — for example, to send sound trucks to Prince George’s County — is just woefully inadequate. It’s like trying to give someone an umbrella in a hurricane, and saying, ‘Have at it. Good luck.’
“There needs to be a lot more that’s done to address the true causes of why Black Marylanders are being vaccinated less than white Marylanders.”
Schrader responded by pointing to the existing efforts, and said state data might be underestimating the actual number of Black Marylanders inoculated.
“Of course, it’s not where it needs to be,” Schrader said. “So I don’t want to say that will solve the whole problem. We’ve got clues here we’ve got to continue to analyze.”
Charles Gischlar, a Maryland Department of Health spokesman, said officials are weighing a number of factors in regard to further expanding eligibility. It will depend on future allocations from the federal government, as well as the share of eligible groups that already have been vaccinated.
“For now, demand continues to far outpace the limited supply available,” Gischlar said in an email.