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On coronavirus vaccines, Maryland makes West Virginia look good as pace still lags most states, analysis finds

Maryland, which trailed the nation a month ago in COVID-19 vaccine administration, is still vaccinating residents at a rate slower than most other states despite bolstering its dose distribution efforts, according to data collated by the federal government.

The state is quickly expanding eligibility and adding vaccination clinics, as officials continue to cite a critical shortage of shots to explain the delays in Maryland’s rollout. And state officials point to another new analysis showing Maryland’s rate of shots administered daily spiking in recent days, to more than 20,000 shots daily.

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However, the U.S. government doles out doses based on states’ populations, and federal health data shows Maryland hasn’t efficiently administered its allotment compared with other states.

Maryland’s reliance on counties in the rollout is partially to blame for the pace, found an analysis by the Brookings Institution, a research group based in Washington, D.C.

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That stands in stark contrast with West Virginia, which has at times paced the United States in giving shots to residents — partially, the study by William Galston determined, because it adopted a more centralized approach to the vaccine rollout.

But Galston admits the picture of where Maryland stands is incomplete. That’s in part because data presented by the U.S. Centers for Disease Control and Prevention differs from what shows up on the Maryland Department of Health’s coronavirus vaccination dashboard.

Maryland has given first shots of the vaccine to about 5.6% of its population and fully vaccinated 0.8%, the 35th and 47th out of 50 states and Washington, D.C., according to an analysis of CDC data. The latest figures from the Maryland health department show the state has given first doses to about 6% and fully vaccinated just under 1%, figures which would rank it at 28th and 39th nationally.

The state and federal figures could differ due to reporting delays, manual entry errors and state-by-state discrepancies, according to the CDC. On Wednesday, it reported that 47% of the 820,425 vaccines distributed to the state had been administered. The state reported 49% of the 852,625 of the vaccines had been administered.

Southampton Middle School nurse Michele Keeney talks with Joppatowne Elementary School teacher Aaron Keithley as he arrives for his COVID-19 vaccination during the vaccination clinic at Patterson Mill Middle / High School Wednesday, January 27, 2021.
Southampton Middle School nurse Michele Keeney talks with Joppatowne Elementary School teacher Aaron Keithley as he arrives for his COVID-19 vaccination during the vaccination clinic at Patterson Mill Middle / High School Wednesday, January 27, 2021. (Matt Button / The Aegis/Baltimore Sun Media)

State health department spokesman Charles Gischlar said the nation’s governors raised concerns Tuesday with the White House about the CDC’s reporting process. He said the state’s biggest problem stems from its allotment, rather than its organization.

“The major issue in Maryland, as in many other states, is not enough vaccines are being allocated to the state from the federal government. Our vaccination program has one strategic goal: getting shots into arms to as many people as fast as possible,” Gischlar said in an email. He pointed to distribution via pharmacies at Giant, Martins and Walmart and, starting next week, Rite Aid and Safeway.

“We are using every outlet that is available to us to accomplish this,” he said.

Among states, Maryland ranks 46th according to CDC data and 39th per health department data in the percentage administered of the doses it’s received from the government. West Virginia ranks second in the nation. It has received approximately 278,400 shots and administered about 77% of them. About 52% of the doses distributed to states nationwide have been administered.

Maryland has more than 6 million residents; West Virginia about 1.8 million, the U.S. Census Bureau estimates. And CDC data shows Maryland’s neighbor has given first doses to approximately 9.5% of its population, or 169,671 people, and second doses to 2.52% of its population, or 45,244 people. Those are the second and first highest proportions in the nation.

The revelation shocked Galston, a Montgomery County resident. He set out to find out how one of the poorest states in America is immunizing more efficiently than its much wealthier neighbor. Key to West Virginia’s success was the state’s decision to rely upon a network of independent drugstores to immunize nursing homes instead of a federal partnership with national pharmacy chains, Galston said. Strong statewide decisions also played a role.

“West Virginia has adopted a more centralized approach to the problem with a really direct relationship between the governor’s office and individual activities and individual institutions in the state,” said Galston, a senior fellow of governance studies at the D.C. think tank. This prevented confusion and competition among localities, he explained in the analysis.

Meanwhile, Galston wrote in the study, Maryland deferred to its counties, a move “impeding vaccine delivery during this pandemic. As Maryland residents know, this diversity has created confusion and has given residents with access to multiple information sources advantages over those with weaker networks and less Internet access. A bewildering maze of online sites — some from counties, others from hospitals — has sprung up.”

Galston knows not only from his research. He just got his shot Tuesday, and it was no easy feat. After securing an appointment online, he drove all the way to Caroline County on the Eastern Shore. He said a health worker turned him away from the clinic because the county had stopped immunizing non-county residents. Frustrated, he called his wife from the parking lot, worried it would be weeks or months before he got immunized.

The same worker tapped on his window later, Galston, 75, recalled. “[She said] ‘It’s the end of our inoculation day, and we have one dose left. Do you want it?’ I didn’t need to be asked twice.”

His experience cuts to the heart of what his analysis described, a disjointed and confusing system, and underscored the stories that Marylanders have relayed about trying to sign up for the vaccine. Seniors have said it’s difficult to navigate the network of almost exclusively online registration process. Furthermore, there’s concern among experts that shots aren’t reaching the minority populations it devastated most.

Anita Hawkins, assistant dean of Morgan State University’s School of Community Health and Policy, said the report highlights the importance of understanding regional nuances during emergencies. She said Maryland’s independently run county systems mean that each will operate by unique standards and potentially compete for resources rather than work collaboratively.

“It’s really important to move forward and to look at these differences,” said Hawkins, who also is directing the institution’s COVID-19 response. “In a state, there are multiple communities, and each jurisdiction has a different profile. But you still have to understand how things operate, and listen across the board.”

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Also to blame, according to Galston’s analysis, was Maryland’s decision to join the federal partnership with CVS and Walgreens, which hampered rollouts nationwide with a slow start inoculating nursing home residents as they were contracted to do.

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But the pharmacies have since picked up the pace, said Mike Ricci, a spokesman for Gov. Larry Hogan. He said CVS is about 70% of the way through giving second shots to residents and staff.

There is cause for optimism in Maryland’s vaccine rollout, as the state has ramped up the pace of shots administered daily, Ricci said. He referred to a Bloomberg analysis that showed Maryland’s rate of shots administered daily over the last week ranked 17th nationally.

“Maryland is now averaging more than 20,000 shots a day,” he said in an email. “That’s a 55% increase over the last two weeks.”

Ricci pushed back on the idea that the state too heavily relied on counties to carry out the vaccination campaign, saying Maryland has “only asked counties to vaccinate their vaccinators, first responders, and priority populations.” Health officials estimate the first priority groups represent about 2 million to 3 million people, or a third to half of the state’s population.

Local health department and hospital workloads will be alleviated by the infrastructure the state is building to administer doses to the greater population, Ricci said. Hogan announced Tuesday the state was opening mass vaccination sites, reassigning members of the National Guard to bolster the vaccination campaign and expanding eligibility to the severely immunocompromised.

During the news conference, the Republican governor sought to set expectations straight: There’s a severely limited supply and the state’s vaccinators are doing what they can with it.

“We can’t fix all of these problems by ourselves,” Hogan said Tuesday. “We can’t fix them overnight.”

Galston figures the governor’s remarks did some good. But he wants more timely, easily accessible data and updates. It’s been difficult even for him as a professional researcher to find answers.

“Information, even if it’s not particularly pleasant information, even if it’s not what you want to hear, is so much better than a lack of information.”

Baltimore Sun reporter Meredith Cohn contributed to this article.

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