Two months into the effort to vaccinate the public against COVID-19, the administration of Maryland Gov. Larry Hogan reversed course and said it would launch an official, though limited, waitlist to ease the frustrating hunt for scarce doses.
The Republican governor decided against a preregistration system last year before vaccine began arriving and turned aside recent calls for a one-stop site, repeatedly saying it could become “a single source of failure.”
The state instead allocated shares of the vaccine to hospitals, county health departments, pharmacies and others, allowing them to sign up people using their own systems. The resulting balkanized system has frustrated many of those seeking a vaccine and prompted criticism from state and federal lawmakers from Maryland.
The newly planned state site, scheduled to launch sometime next month, wouldn’t incorporate all the places offering vaccines, only the state’s mass sites. It would leave out pharmacies, health centers, hospitals and other sites, prompting observers and other lawmakers to offer only limited praise.
“That’s a step in the right direction, there’s no doubt about it,” said U.S. Rep. Anthony Brown, a Democrat who is sponsoring a bill that would set up a national website and offer grants to states to develop state-level vaccine appointment booking websites.
“Since the governor has the ability to direct the allocations throughout the state, I would hope this would just be the first step in the effort to centralize the entire allocation and administration of the statewide vaccination program,” he said.
Brown faced his own criticism in 2013 when he was Maryland’s lieutenant governor and oversaw the state’s new health exchange where people could buy insurance under the Affordable Care Act. The site crashed on the first day and ultimately had to be replaced with costly new technology.
“I think Governor Hogan is afraid of failure,” Brown said. “He’s afraid if he assumes responsibility for a centralized system and it doesn’t work, he will be criticized and critiqued.”
But he and others said the state’s proposed preregistration site should be expanded. For now, it will only allow people to sign up for the state’s mass vaccination sites in Prince George’s County and at the Baltimore Convention Center, plus one scheduled to open Thursday at M&T Bank Stadium in Baltimore. Another site in Southern Maryland is planned to open next month, and others are on the drawing board. People still would have to add their names to sites run by counties and others online or by phone.
State officials did not answer other questions about the proposed sign-up site, including who would operate the portal or whether other vaccination centers eventually will be included.
“We will be discussing it with the counties on our next call with them, and get their input,” said Charles Gischlar, a spokesman for the state health department, in an email Tuesday, a day after acting health secretary Dennis R. Schrader announced the new preregistration site.
State Sen. Clarence Lam, a physician, called the effort a late attempt to create a coordinated website and “another example of the state not anticipating problems and working to prevent them.”
He said he was concerned the promised state portal might be too limited and too late to fix the confusion and frustration over vaccine access. He said there are too many unknowns about how the site will work to know whether it will be effective.
For example, he said, it’s unclear if the state’s new system can work with the different patient data systems used by different operators of the mass vaccination sites.
”I think it’s a step in the right direction, but I question how much it’s actually going to be helpful,” said Lam, a Democrat who represents Howard and Baltimore counties. “The devil is in the details in all this.”
The tangle of technology used by providers has vexed vaccine seekers who have been turned away when limited doses are quickly spoken for. Some have turned to private Facebook pages and other resources to guide them in their pursuit, which some have likened to a scavenger hunt or the Hunger Games.
And though the state has disbursed more than 1.1 million doses, data shows Maryland remains behind most other states in getting shots into arms, ranking 41st of 50 states and the District of Columbia for the number of doses it has administered per 100,000 residents, according to data from the U.S. Centers for Disease Control and Prevention.
Critics also say the way doses are distributed benefits the tech-savvy, and those able to drive anywhere anytime at the expense of older people and minority groups.
The health department’s Gischlar said the new registration portal could “further free up hospitals and local health departments to focus on ensuring equitable access, and reaching hard-hit communities.”
Hogan and others agree the biggest issues will be resolved once more vaccine is made available. So far, demand has outstripped the supply of vaccine.
It’s not clear when states can expect their vaccine allocations from the federal government to jump, but federal regulators are reviewing a third vaccine for emergency use and it could gain that authorization by week’s end.
For now, the state reports it is receiving about 12,000 doses a day to vaccinate the more than 2 million people who currently qualify.
Maryland officials had planned to collect the names of people interested in the vaccine before it began arriving in December, according to local health officials. Many local health departments created their own waitlists when the state did not create one.
One system available at the time to state officials, called COVIDReadi, billed itself in a brochure circulated last fall as a preregistration system able to help providers identify specific groups who qualified for vaccine by age, race, address and other factors.
It was created by an Owings Mills-based nonprofit called Maryland Partnership for Prevention, which is normally responsible for helping vaccinate school kids against the flu. The partnership also developed a vaccine registration and tracking system called PrepMod that the state issued to every local health department. It’s also used by about a dozen Maryland hospitals and 26 other states.
The preregistration and registration systems were designed to work together.
Tiffany Tate, the Partnership for Prevention’s executive director, developed the registration system after the H1N1 outbreak in 2009. She said she watched in disbelief as workers collected information from people in line on clipboards to be manually entered into computers later. The PrepMod system she created has been used in schools around the state for flu vaccine registration and tracking for the past several years.
She said when the coronavirus pandemic was emerging she was astounded to learn another system had not been developed to manage vaccine distribution and tracking. She retooled PrepMod and has continued making improvements as issues have come up, such as people sharing registration links and overbooking, problems she never had with flu vaccinations.
Both Tate and state officials said more training was upcoming on the patches.
“It’s remarkable to me that 10, 11 years later the government still hadn’t given us a product like that,” she said. “I adapted this one. But there are still perils with any technology.”
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Ed Singer, the Carroll County health officer, said it might not matter if the state offered local counties the option to use whatever preregistration system it adopts. His department has been working closely with community partners to create a priority list and it may be hard to change “mid-effort.”
Some proponents of a centralized waitlist agree it could cause disruption if it failed, as happened with the health exchange. The state’s Beacon One-Stop system for unemployment insurance also has had its troubles, trapping some users in limbo without benefits.
But a universal preregistration site would be particularly useful in this case, said Tinglong Dai, an associate professor of operations management and business analytics in the Johns Hopkins Carey Business School who has been following vaccine distribution.
One-stop preregistration sites are “not only a logical thing to do, but probably the only option one has when the demand outstrips supply in the short term,” he said. “It’s also not surprising that many other states are considering the same direction.”
Dai said it could be a challenge to make a site trustworthy and useful. It would have to offer registered users information such as their updated wait times and how they connect to appointment slots when they are available. It also might be tough to include all the disparate sites now offering vaccines in Maryland.
That doesn’t mean the state’s leadership shouldn’t try.
“The idea that a centralized managed website can become a ‘single source of failure’ is not without merit,” Dai said. “But great leaders should be motivated by a desire to deliver excellent results, not by a fear of failure. Given the status quo of Maryland’s vaccination effort, there is very little downside. The upside potential is huge.”