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Maryland hopes adding pharmacies to COVID vaccine rollout will expand its reach

When Baltimore resident Phyllis Fung heard that some pharmacies were going to offer the COVID-19 vaccine in Maryland, she rushed to check their websites. The 53-year-old had “frantically” tried health departments and hospitals to get her elderly parents and in-laws immunized.

Her dad eventually got his first shot through the hospital system where he’s a patient and her mom got an appointment at a Giant pharmacy, one of the first to offer vaccines. But she couldn’t find anything for her in-laws — both over 75. Then the state announced that Rite Aid and Safeway were joining the mix.

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“I went to the Rite Aid site and I kept putting in my father-in-law’s birthday and it kept saying he wasn’t eligible,” Fung said.

She tweeted at the company; they told her to wait and try again. She checked and checked, and finally it accepted him. She got an appointment for him and another, a week later, for her mother-in-law.

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Stories like Fung’s are what Maryland officials hoped for when they opted into a federal partnership that sends some of the state’s coronavirus vaccine allocation directly to large-scale retail pharmacies throughout the state — that more providers will reach more people. About 51 Giant, Walmart, Safeway and Rite Aid pharmacies in Maryland are vaccinating as part of the federal program, said Charles Gischlar, a Maryland Department of Health spokesman.

But critics worry the state acted too soon to expand vaccine distribution, stretching an already scarce supply of doses even thinner. Some lawmakers said sending vaccines to pharmacies means diverting doses from the providers who’ve administered them most efficiently: local health departments and hospitals. Meanwhile, some county health officers are irked about being cut out despite saying they can best reach vulnerable people.

“Why are we sending more vaccines to the Walmart and CVS when the health departments, which are doing a great job as it is, can’t get more vaccines on their own?” said Sen. Clarence Lam, a Democrat who represents parts of Baltimore and Howard counties.

The state’s decision is reflective of a “decentralized” approach to rolling out immunizations, said Lam, who is a physician.

“I think early on during the vaccine distribution, particularly when the vaccine supply is tight and inefficient, I think a more centralized strategy is critical,” Lam said.

Addressing the Maryland Senate Vaccine Oversight Workgroup last week, acting Health Secretary Dennis R. Schrader described the decision to include pharmacies as a preliminary test to avoid hiccups when the supply of the vaccine increases and the federal government floods the stores with doses once more vaccines are approved.

“What we’re trying to do is get those things ramped up to make sure that they work in the local jurisdictions,” Schrader told the lawmakers.

To vaccinate residents and staff members in nursing homes and assisted living facilities, the state tapped a federal program that uses CVS Health and Walgreens. Separately, CVS announced last week that it plans to open 18 pharmacies across Maryland next week to administer COVID-19 vaccines to eligible residents. All CVS doses will come from the federal government, Gischlar said.

More than 2 million Marylanders are estimated to be eligible now for the vaccine, which is open to people 65 and older, front-line health care workers and first responders, educators, and certain essential workers, among other groups. Many people in the first priority groups — including people 75 and older — still need shots, and preliminary state data shows the rollout is lagging in reaching Maryland’s minorities.

It’s unclear how efficiently pharmacies are administering their doses. As of Feb. 1, state health department data showed Maryland had diverted 96,625 vaccine doses to pharmacies — approximately 3% of its total allocation — but the drugstores have given 45,683 shots, about 47% of their allocation. Some say, however, those figures are at odds with what’s actually happening.

Schrader told the Senate panel last week that both Giant and Walmart say they’ve used all the doses they’ve gotten. In an email, Gischlar said the health department is working with pharmacies to ensure all their vaccinations are reported promptly.

It’s good the state and pharmacies are working out the kinks before the supply of vaccines balloons, said Crystal Watson, senior associate at the Johns Hopkins Center for Health Security.

But, Watson said, Maryland needs to better communicate who should seek out vaccines and where they should sign up amid a disorienting array of options. The health department couldn’t say last week whether Marylanders should sign up with multiple potential providers.

“This is an awkward place to be in right now: We don’t have enough to make it really widely available, but we have enough that we need to start vaccinating more people,” Watson said. “So I think right now it is just going to be inherently confusing and a little bit chaotic until we switch over to a broader vaccination approach, which I think is coming.”

No matter the chaos, adding pharmacies to the rollout is an important step in immunizing as many people as possible, she said.

“I think behind doctors and nurses, pharmacists are the most trusted health care providers in the country,” Watson said.

But Lam and Sen. Addie Eckardt, a Republican who represents four Eastern Shore counties, are concerned about how pharmacies are deciding who among the eligible should get their shots first and verifying people’s eligibility.

“The feedback,” Eckardt said, “is they’re not.”

They worried the pharmacies only add to the confusing network of online vaccine registrations, each with a different sign-up and vetting process.

The pharmacies relayed varying accounts in responses to questions from The Baltimore Sun.

A spokeswoman for Safeway, which is vaccinating at 11 stores, said its pharmacies are “following local jurisdictions’ guidelines in terms of who receives the vaccine.” A spokesman for Rite Aid, which has five active vaccine locations in Maryland, said it checks through a prescreening form. Neither could say how many doses they had administered.

Meanwhile, a spokeswoman for Walmart did not respond to questions about vetting eligibility or prioritization, though the company’s website says it’s administering vaccines based on state and federal guidelines.

Samir Balile, clinical programs manager for Giant Pharmacy, said the company does a “soft vetting” to ensure someone’s eligibility and checks identification at the time of the appointment. Among those eligible, it’s first-come, first-served at Giant.

“There’s no hierarchy,” Balile said. “It’s literally if you fall in those categories,”

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As of Wednesday, Giant had given 6,400 first shots to people at 22 Maryland stores, he said.

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“Essentially we were told to put shots in arms, and that’s what we’ve done,” Balile said.

Fung took her mother for her first dose at a Giant in Dundalk. She said the pharmacy was organized and efficient in administering vaccines. But something else stuck out to her.

She said an elderly man showed up trying to get an appointment for a shot, but the store told him he should sign up online — the grocery’s vaccine sign-up is exclusively online, like most of the systems. But he didn’t have a computer or internet access. She said it seemed he didn’t know what to do.

That’s why Carroll County Health Officer Ed Singer said the state should focus the rollout through local health departments and hospitals, which he described as better equipped to reach vulnerable residents and to prioritize among those who are eligible.

“We’re making personal phone calls to people who are on our list because they don’t know how to use the computer, they don’t know how to sign up for the clinic themselves and we need to actually walk them through the process and actually put them in there,” Singer, president of the Maryland Association of County Health Officers, told the state’s House Health and Government Operations Committee last week. “I don’t think that the other partners in this program are going to be able to do that for people.”

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