Policy skewed vaccine doses
Many of state’s populous counties got smaller per capita shares of shots
A COVID-19 vaccine allocation policy from the Maryland Department of Health saw the state send a disproportionately small supply of vaccines to more populated counties when adjusted per capita, according to data from the first 11 weeks of vaccinations.
From Dec. 14 through Feb. 28, all but one of Maryland’s six most populous jurisdictions received below average per capita allocations of first vaccine doses — and three were in the bottom five. All of the state’s six least populous jurisdictions had above average allocations per 1,000 residents — and three were in the top five.
State health officials have been saying vaccines were being distributed proportionate to populations.
Yet there was a more than three-fold difference in first doses delivered per capita between the top county — which is also the least populated in the state — and the county with the smallest share — the fifth most populous.
The state health department attributed the disparity to a policy that grouped counties together in three allocation categories based on their populations.
With about 19,000 people, Kent County got 283 first doses per 1,000 residents — the most in the state. It received 5,500 first doses from the state over the first two and half months of vaccinations, according to state health department data. Anne Arundel County, population 579,000, got 88 initial doses per 1,000 residents — the lowest rate in the state. It received 50,850 first doses from the state’s supply.
“I appreciate the fact that these numbers have been made public because
they tell a story that needed to be told,” said Anne Arundel County Executive Steuart Pittman. “The bottom line is that we need more doses, whether they come to our health department, hospitals, pharmacies, or a state site. Send those vaccines to Anne Arundel County, and please do it soon!”
Tops in the state for much of the vaccination effort, Kent has given a first dose to nearly 24% of its population; 16% of Anne Arundel residents have gotten a first dose, which is below average.
State Sen. Clarence Lam, a physician who represents parts of Baltimore and Howard counties, both of which ranked near the bottom of per capita doses, called the state’s method of ensuring equitable vaccine distribution insufficient. He said it must account for the number of vaccine doses administered and consider factors like counties’ shares of COVID-19 cases and deaths.
“Even if you were to accept their definition of equitable distribution, which is deficient, they’re not meeting their own standard,” said Lam, a Democrat who sits on the legislature’s Vaccine Oversight Workgroup, a body tasked with overseeing the immunization campaign of Republican Gov. Larry Hogan’s administration.
In response to questions from The Baltimore Sun about the disparate distribution, a health department spokesman blamed a January decision to set minimum first dose allocations for local health departments.
“Some counties with lower populations benefited from this policy,” Charles Gischlar said in an email.
Gischlar said the state decided, in collaboration with local health leaders, on weekly “floors” for each local health department, grouping counties into three categories: a department for a county with less than 100,000 people got a minimum of 300 doses, one for a jurisdiction with between 100,000 and 200,000 residents got a minimum of 700 doses, and an agency for a county of more than 200,000 got no less than 975 doses.
Democratic senators at the time questioned the department’s thinking, with Senate President Bill Ferguson pointing out that the formula meant Harford County, with about 255,000 people, was guaranteed the same minimum as Montgomery County, which has more than 1 million residents. It also meant tiny Kent County had the same floor as Calvert County, which is more than four times larger with a population 92,525. “That proportion doesn’t really compute well in my mind,” said Ferguson, who created and chairs the vaccine oversight group.
“We’re always fine tuning this,” responded Dennis R. Schrader, the state’s acting health secretary. He noted that the proportions were minimums, that “health departments generally get more than that” and that immunizations were being sent to other providers in the jurisdictions.
At a workgroup meeting two weeks later, Lam questioned Schrader about how the state was divvying its share of vaccine doses. Schrader said the doses per 1,000 residents was the “baseline calculation.”
Almost three months into Maryland’s vaccination campaign, Lam still doesn’t understand how the state distributes doses. Lam’s phone frequently floods with messages from local health officials and politicians who are equally perplexed, he said, and the health department has declined repeated requests from lawmakers for comprehensive vaccine allocation and administration data.
“It’s really disappointing because at the end of the day there needs to be transparency about how these doses are being allocated. It should not be a secret, some formula in a black box,” Lam said. “This is the number one priority for Marylanders.”
A Goucher College poll released Monday found that two-thirds of Marylanders rated the state’s distribution of vaccines poor or fair with only a third calling it good or excellent.
Gischlar said the health department has shifted now to a strategy that prorates allocations based on county populations, but which considers every vaccinator in each jurisdiction, how many doses those providers have on hand and how efficiently the vaccines are being utilized.
“Our goal is to try to balance the population-based allocation across jurisdictions,” he said.
Gischlar didn’t say when the change took effect or explain the prior strategy.
Over the first 11 weeks of vaccinations, the state’s allocations resulted in initial immunizations going into the arms of more than three times as many white people as Black people, according to state vaccine data. Latino people received about 4% of the first doses for which the recipients ethnicity was documented.
Prince George’s County, which according to U.S. Census Bureau estimates has the largest combined proportion of Black and Latino residents in Maryland, got the third fewest first doses per 1,000 residents over the first 11 weeks of vaccinations.
Prince George’s also has the lowest vaccination rate in the state even though it is home to the state’s first mass vaccination site.
The state data on vaccine allocation does not include those from a federal program with Walgreens and CVS to inoculate nursing home residents and staff or those for mass vaccination sites that were not set aside for residents of the county.
Black and Latino residents have been hit hard by the coronavirus, with some predominantly Black or Latino ZIP codes being devastated by the disease.
Some of those communities are in Baltimore City, which stood as an outlier as far as how many first doses per capita it received, yet has a vaccination rate among the lowest in the state.
It is the state’s fourth most populous jurisdiction with 593,000 people. Unlike its more populated peers it fared well with 211 doses per 1,000 residents — the third highest in the state.
But most of Baltimore’s allocation — almost 75% — went to its 11 hospitals, according to more detailed data released by the state. Front-line health care workers were prioritized first in the state’s rollout and many of those who staff Baltimore’s hospitals live outside city limits. The hospitals also serve patients from around the state.
As of Monday, just under 38% of first doses administered in the city have gone to city residents.
Montgomery, Baltimore and Howard counties — the state’s first, second and sixth most populous jurisdictions — all had per capita rates below the 24-county average of 152 doses per 1,000 people. All of those jurisdictions have proportions of Black and Hispanic residents above the 24-county average of about 25%.
At the top, along with Kent County and Baltimore City, were Dorchester County with 216 first doses per 1,000 residents, Garrett County with 207 initial vaccines per 1,000, and Worcester and Talbot counties, each with 202.
About 35% of Dorchester’s approximately 32,000 people are Black or Hispanic. Garrett has 29,000 residents, Worcester has 52,000 and Talbot has 37,000. None of those jurisdictions’ populations are more than 20% Black and Latino.
Garret, Worcester and Talbot all have above average initial vaccination rates, with the latter pacing the state as of Monday morning. Dorchester is below average.